Chronic widespread pain and the risk of cardiovascular disease-a systematic review and meta-analysis

Previous research indicates that individuals with chronic widespread pain (CWP) have an excess risk of cardiovascular disease. Given the high global prevalence of CWP, this association may have substantial public health implications. Our objective was to summarise the current evidence on the association between CWP and incident cardiovascular disease in a systematic review and meta-analysis. We searched major databases (MEDLINE, Embase, Web of Science, and Cochrane) and included studies based on predefined eligibility criteria. We identified 18 studies reporting associations between CWP (n = 80,021) and atherosclerotic diseases or cardiovascular mortality (n events = 33,799). In the meta-analysis, we removed studies that analysed identical outcomes in the same population. Individuals with CWP had an almost doubled risk of atherosclerotic diseases, RR 1.94 (95% confidence interval [CI]: 1.56-2.41), and for cardiovascular mortality, the RR was 1.61 (95% CI: 1.24-2.08) in the minimally adjusted models. In the maximally adjusted model, the RR for atherosclerotic diseases was 1.53 (95% CI: 1.27-1.86) vs RR 1.12 (95% CI: 0.93-1.34) for cardiovascular mortality. The heterogeneity was high and potential publication bias was indicated for the mortality analysis. This meta-analysis, although based on relatively few studies with high heterogeneity, shows that CWP is consistently associated with incident atherosclerotic disease. Evidence for an association with cardiovascular mortality is less conclusive. Individuals with CWP may represent an underrecognized high-risk group for atherosclerotic diseases that could benefit from proactive cardiovascular risk assessment and intensified prevention. Further high-quality studies are warranted to confirm the strength and causality of the association.