Korean Circ J.  2011 Oct;41(10):596-602. 10.4070/kcj.2011.41.10.596.

Arterial Stiffness in Female Patients With Fibromyalgia and Its Relationship to Chronic Emotional and Physical Stress

• Lee JH
• Cho KI
• Kim SM
• Lee HG
• Kim TI

• KMID: 2297919
• DOI: http://doi.org/10.4070/kcj.2011.41.10.596

Abstract

BACKGROUND AND OBJECTIVES
In patients with fibromyalgia (FM) syndrome, stress and pain may chronically enhance sympathetic activity, altering cardiovascular responses and inducing the arterial wall-stiffening process. We investigated arterial stiffness in FM patients using pulse wave velocity (PWV) and analyzed whether arterial stiffness was affected by the clinical parameters of FM.
SUBJECTS AND METHODS
This study included 108 female FM patients (51.5+/-8.9 years) without any known cardiovascular diseases and 76 healthy female controls (50.1+/-8.9 years). FM patients underwent a manual tender point survey for tender point counts, and completed the visual analogue scale (VAS) of pain and fibromyalgia impact questionnaire (FIQ), which were composed of a physical and feel score. Brachial-ankle pulse-wave velocity (baPWV) was measured with an automated device. The study participants were subdivided into 2 groups based on the sum of the FIQ score (group A: FIQ > or =50, group B: <50).
RESULTS
Patients with FM had significantly higher baPWV than the controls, and significant increase were noted in baPWV values of group A compared with those of group B. BaPWV showed a significant positive correlation (correlation coefficient=6.83, p=0.022) with severity of disease assessed by FIQ.
CONCLUSION
The patients with FM showed significantly increased arterial stiffness, suggesting a pathophysiologic link between FM and endothelial dysfunction. This study provides a basis for clarifying the mechanism by which chronic pain syndrome is associated with an increased risk of vascular stiffness.

Keyword

Fibromyalgia; Compliance; Stress; Pulse wave velocity

MeSH Terms

Aluminum Hydroxide
Carbonates
Cardiovascular Diseases
Chronic Pain
Compliance
Female
Fibromyalgia
Humans
Pulse Wave Analysis
Vascular Stiffness
Surveys and Questionnaires
Aluminum Hydroxide
Carbonates

Figure

• 

  Fig. 1 Regression analysis between parameters of fibromyalgia functional status and brachial-ankle pulse wave velocity (baPWV). FIQ (A), pain VAS (B) and subscales of depression (C), anxiety (D), and fatigue (E) showed significant effect on baPWV. FIQ: fibromyalgia impact questionnaire, VAS: visual analog scales.

Reference

1. Wallace J, Clauw J. Wallace DJ, Clauw DJ, editors. Epidemiology of chronic widespread pain and fibromyalgia. Fibromyalgia and other Central Pain Syndromes. 2005. Philadelphia: Lippincott Williams & Wilkins;17–29.

2. Giske L, Vøllestad NK, Mengshoel AM, Jensen J, Knardahl S, Røe C. Attenuated adrenergic responses to exercise in women with fibromyalgia: a controlled study. Eur J Pain. 2008. 12:351–360.

3. Martinez-Lavin M. Biology and therapy of fibromyalgia: stress, the stress response system and fibromyalgia. Arthritis Res Ther. 2007. 9:216–222.

4. Strawn WB, Bondjers G, Kaplan JR, et al. Endothelial dysfunction in response to psychosocial stress in monkeys. Circ Res. 1991. 68:1270–1279.

5. Manuck SB, Kaplan JR, Adams MR, Clarkson TB. Effects of stress and the sympathetic nervous system on coronary artery atherosclerosis in the cynomolgus macaque. Am Heart J. 1988. 116:328–333.

6. Rajagopalan S, Brook R, Rubenfire M, Pitt E, Young E, Pitt B. Abnormal brachial artery flow-mediated vasodilation in young adults with major depression. Am J Cardiol. 2001. 88:196–198.

7. Harris KF, Matthews KA, Sutton-Tyrrell K, Kuller LH. Associations between psychological traits and endothelial function in postmenopausal women. Psychosom Med. 2003. 65:402–409.

8. Hirsch AT, Criqui MH, Treat-Jacobson D, et al. Peripheral arterial disease detection, awareness, and treatment in primary care. JAMA. 2001. 286:1317–1324.

9. Wallace J, Clauw J. Wallace DJ, Clauw DJ, editors. Symptoms and signs of Fibromyalgia syndromes: an overview. Fibromyalgia and Other Central Pain Syndromes. 2005. Philadelphia: Lippincott Williams & Wilkins;127.

10. Wolfe F, Smythe HA, Yunus MB, et al. The American College of Rheumatology 1990 criteria for the classification of fibromyalgia: report of the Multicenter Criteria Committee. Arthritis Rheum. 1990. 33:160–172.

11. Bae SC, Lee JH. Cross-cultural adaptation and validation of the Korean myalgia impact questionnaire in women patients with fibromyalgia for clinical research. Qual Life Res. 2004. 13:857–861.

12. Yamashina A, Tomiyama H, Takeda K, et al. Validity, reproducibility, and clinical significance of noninvasive brachial-ankle pulse wave velocity measurement. Hypertens Res. 2002. 25:359–364.

13. Tomiyama H, Yamashina A, Arai T, et al. Influences of age and gender on results of noninvasive brachial-ankle pulse wave velocity measurement: a survey of 12517 subjects. Atherosclerosis. 2003. 166:303–309.

14. Baron R, Levine JD, Fields HL. Causalgia and reflex sympathetic dystrophy: does the sympathetic nervous system contribute to the generation of pain? Muscle Nerve. 1999. 22:678–695.

15. Wittstein IS, Thiemann DR, Lima JA, et al. Neurohumoral features of myocardial stunning due to sudden emotional stress. N Engl J Med. 2005. 352:539–548.

16. Zaroff JG, Rordorf GA, Titus JS, et al. Regional myocardial perfusion after experimental subarachnoid hemorrhage. Stroke. 2000. 31:1136–1143.

17. Vita JA, Treasure CB, Yeung AC, et al. Patients with evidence of coronary endothelial dysfunction as assessed by acetylcholine infusion demonstrate marked increase in sensitivity to constrictor effects of catecholamines. Circulation. 1992. 85:1390–1397.

18. Mohri M, Koyanagi M, Egashira K, et al. Angina pectoris caused by coronary microvascular spasm. Lancet. 1998. 351:1165–1169.

19. Cho KI, Lee JH, Kim SM, et al. Assessment of myocardial function in patients with fibromyalgia and the relationship to chronic emotional and physical stress. Korean Circ J. 2010. 40:74–80.

20. Cho KI, Lee JH, Kim SM, et al. Assessment of endothelial function in patients with fibromyalgia-cardiac ultrasound study. Clin Rheumatol. 2011. 30:647–654. doi: 10.1007/s10067-010-1599-8.

21. Joannides R, Haefeli WE, Linder L, et al. Nitric oxide is responsible for flow-dependent dilatation of human peripheral conduit arteries in vivo. Circulation. 1995. 91:1314–1319.

22. Wilkinson IB, Qasem A, McEniery CM, Webb DJ, Avolio AP, Cockcroft JR. Nitric oxide regulates local arterial distensibility in vivo. Circulation. 2002. 105:213–217.

23. Fishbane S, Youn S, Kowalski EJ, Frei GL. Ankle arm blood pressure index as a marker for atherosclerotic vascular diseases in hemodialysis patients. Am J Kidney Dis. 1995. 25:34–39.

24. Newman AB, Tyrrell KS, Kuller LH. Mortality over four years in SHEP participants with a low ankle arm index. J Am Geriatr Soc. 1997. 45:1472–1478.

25. Boutouyrie P, Tropeano AI, Asmar R, et al. Aortic stiffness is an independent predictor of primary coronary events in hypertensive patients: a longitudinal study. Hypertension. 2002. 39:10–15.

26. Lee YS, Kim KS, Nam CW, Kim YN. Increased arterial stiffness in patients with cardiac syndrome X-pulse wave velocity in cardiac syndrome X. Korean Circ J. 2005. 35:424–428.

27. Tomiyama H, Koji Y, Yambe M, et al. Brachial: ankle pulse wave velocity is a simple and independent predictor of prognosis in patients with acute coronary syndrome. Circ J. 2005. 69:815–822.

28. Rhee MY, Lee HY, Park JB. Measurements of arterial stiffness: methodological aspects. Korean Circ J. 2008. 38:343–350.

29. Leicht AS, Hirning DA, Allen GD. Heart rate variability and endogenous sex hormones during menstrual cycle in young women. Exp Physiol. 2003. 88:441–446.

30. Cooke WH, Ludwig DA, Hogg PS, Eckberg DL, Convertino VA. Does the menstrual cycle influence the sensitivity of vagally mediated baroreflexes? Clin Sci (Lond). 2002. 102:639–644.