Posted on 10/30/2015 by wames

Cort Johnson on the Health Rising Forums asks if people with ME could be susceptible to heart disease, as research suggests for people with Fibromyalgia. Is Heart Disease in ME/CFS and FM Patients Future? 23, Sep 2015

Coronary heart disease (CHD) occurs when plaque builds up on the arteries that supply blood to the heart. The plaque buildup can reduce blood flows to the heart causing chest pain – particularly during strenuous activity. If the plaque bursts a clot can form which can block blood flows to the heart causing a heart attack.

CHD is the leading cause of death in the U.S. Despite the fact that it typically shows up about ten years later in women than men it is the leading cause of death in the U.S. for women. This is the second Taiwanese study to find an increased risk of coronary heart disease in people with fibromyaliga. The increased risk of CHD (almost 50%) found was not as high as for diabetes or hypertension, and was described as “moderate”.

Increased Risk of Coronary Heart Disease in Patients with Primary Fibromyalgia and Those with Concomitant Comorbidity—A Taiwanese Population-Based Cohort Study Chia-Hsien Su, Jiunn-Horng Chen, Joung-Liang Lan, Yu-Chiao Wang, Chun-Hung Tseng, Chung-Yi Hsu, Lichi Huang, Published: September 14, 2015 DOI: 10.1371/journal.pone.0137137​

FM patients with diabetes, hypertension, hyperlipidemia, congestive heart failure, cerebral vascular diseases, depression or anxiety had more significantly increased risks of CHD. The risk for CHD was higher, interestingly in FM patients without depression than in people with depression but not FM.

The authors proposed several hypotheses to explain the increased CHD. They rejected the idea that the high use of NSAIDS, antidepressants and pain killers were contributing to it. Instead they suggested that chronic stress, including in some patients early lifetime stressors, increaseid sympathetic nervous system activity and reduced parasympathetic nervous system activity. They noted the reduced heart variability results found in FM, which are a known risk factor for heart disease.

People with chronic fatigue syndrome should note that similar autonomic nervous system findings are found in ME/CFS.

Several studies have found “unfavorable lipid profiles” that could increase the risk of atherosclerosis in ME/CFS. A small 2012 study of women with ME/CFS found high triglyceride and malondialdehyde levels and low levels of the healthy cholesterol (HDL-C). HDL-C is anti-inflammatory agent that prevents cholesterol accumulations on the cell walls and reduces lipid peroxidation.

The authors proposed that these factors may predispose ME/CFS patients to vascular (blood vessel) damage and suggested antioxidant supplement and LDL lowering strategies be employed. A 2005 study found increased levels of oxidized lipids and decreased HDL-C in ME/CFS patients with risk factors (high blood pressure and/or obesity).

High levels of overweight and obesity in fibromyalgia may contribute to the problem although they may not be higher than in the population at large. One study suggested that negative lipid profiles in FM were associated with increased weight – suggesting one possible way to reduce them.

Risk Factors for CHD

A look at the risk factors for CHD finds a mixed bag for people with ME/CFS/FM. Some are probably high (triglycerides, lack of physical activity, sleep apnea, stress) while some major ones (unhealthy diet, smoking, alcohol consumption, high blood pressure) are probably low.

Reduced Physical Activity

Reduced physical activity is important risk factor but the authors of the paper did not suggest it was a factor. The US Guidelines for the amount of aerobic exercise needed to maintain health and ward off illness, however, are probably rarely met by people with fibromyalgia and almost never by people with ME/CFS.

The U.S. breaks activity levels into four categories:

  • Inactive is no activity beyond baseline activities of daily living.
  • Low activity is activity beyond baseline but fewer than 150 minutes (2 hours and 30 minutes) of moderate-intensity physical activity a week or the equivalent amount (75 minutes, or 1 hour and 15 minutes) of vigorous-intensity activity.
  • Medium activity is 150 minutes to 300 (5 hours) minutes of moderate-intensity activity a week (or 75 to 150 minutes of vigorous-intensity physical activity a week). In scientific terms, this range is approximately equivalent to 500 to 1,000 metabolic equivalent (MET) minutes a week.
  • High activity is more than the equivalent of 300 minutes of moderate-intensity physical activity a week.

Aerobic Activity

The U.S. Guidelines state the following amounts of aerobic activity are needed to maintain health and ward off illness. Moderate (such as brisk walking or tennis) or intense (jogging or swimming) should be done in episodes of at least 10 minutes and, if possible, spread out through the week.

  • 150 minutes (2 hours and 30 minutes) each week of moderate-intensity aerobic physical activity (such as brisk walking or tennis)
  • 75 minutes (1 hour and 15 minutes) each week of vigorous-intensity aerobic physical activity (such as jogging or swimming laps)
  • An equivalent combination of moderate- and vigorous-intensity aerobic physical activity

For even greater health benefits, they recommend

  • Increase moderate-intensity aerobic physical activity to 300 minutes (5 hours) each week
  • Increase vigorous-intensity aerobic physical activity for 150 minutes (2 hours and 30 minutes) each week

Is Coronary Heart Disease in ME/CFS and FM Patients Future?

Despite some negative risk factors – not necessarily. The CDC estimates that about 7% of the entire population and about 17% of people over 65 have it. Women have lower rates of CHD (@ 5%) than men but may be more severely affected by it when it does occur.

That suggests that even a 50% increase in the risk factor for CHD would leave the vast majority of middle-aged women with FM (>90%) without it. FM and ME/CFS patients with increased risk factors (depression, anxiety, obesity, increased blood pressure, sleep apnea) would have a higher incidence.

Coronary heart disease is something to think about given the reports of decreased heart rate variability, increased oxidative stress, the high triglyceride findings, the lack of activity, etc. in ME/CFS/FM but it’s certainly not a forgone outcome. More study is clearly needed regarding the long term effects of these diseases.

In the meantime a heart healthy diet, stress reduction, whatever exercise can be done, strategies to reduce inflammation and sleep studies to assess sleep apnea are probably good ideas.

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