Association of inflammatory indices with coronary artery calcium burden in fibromyalgia: A retrospective CT-based...

Fibromyalgia (FM) may involve systemic abnormalities in addition to its characteristic nociplastic pain features. This study aimed to investigate the association between routinely available inflammatory indices, particularly the neutrophil-to-lymphocyte ratio (NLR), and coronary artery calcium (CAC) burden in patients with FM. A total of 142 patients with FM and 64 controls were included. Computed tomography-derived CAC scores were categorized as < 100 or ≥ 100, with CAC ≥ 400 examined as an exploratory threshold. Multiple inflammatory indices were evaluated, and multivariable logistic regression models included demographic and cardiovascular risk factors, with additional adjustment for low-density lipoprotein cholesterol and statin use. NLR differed across the 3 groups after Bonferroni correction for multiple testing; pairwise analysis showed a higher NLR in patients with FM and CAC ≥ 100 than in those with CAC < 100. Among the evaluated inflammatory indices, NLR showed the strongest correlation with CAC score (r = 0.371, Bonferroni-adjusted P < .001). After additional adjustment for diabetes mellitus, hypertension, low-density lipoprotein cholesterol, and statin use, NLR remained associated with CAC ≥ 100 (adjusted odds ratio 3.57, 95% confidence interval 1.15-11.07, P = .028) and CAC ≥ 400 (adjusted odds ratio 3.97, 95% confidence interval 1.14-13.81, P = .030). Receiver operating characteristic analyses showed limited-to-modest discriminatory performance of NLR for CAC ≥ 100 (area under the curve 0.67) and CAC ≥ 400 (area under the curve 0.69). This study identified an independent association between NLR and CAC burden in patients with FM, despite modest between-group differences and limited-to-modest discriminatory performance. These findings are hypothesis-generating and support prospective evaluation of NLR as part of multimarker cardiovascular assessment in FM.