Øhrn Andrea Milde, Nielsen Christopher Sivert, Schirmer Henrik, Stubhaug Audun, Wilsgaard Tom, Lindekleiv Haakon
Faculty of Health Sciences, University of Tromsø, Norway
Norwegian National Advisory Unit on Women's Health, Oslo University Hospital, Oslo, Norway.
J Am Heart Assoc. 2016 Dec 21;5(12):e003846. doi: 10.1161/JAHA.116.003846.
Unrecognized myocardial infarction (MI) is a prevalent condition associated with a similar risk of death as recognized MI. It is unknown why some persons experience MI with few or no symptoms; however, one possible explanation is attenuated pain sensitivity. To our knowledge, no previous study has examined the association between pain sensitivity and recognition of MI.
We conducted a population-based cross-sectional study with 4849 included participants who underwent the cold pressor test (a common experimental pain assay) and ECG. Unrecognized MI was present in 387 (8%) and recognized MI in 227 (4.7%) participants. Participants with unrecognized MI endured the cold pressor test significantly longer than participants with recognized MI (hazard ratio for aborting the cold pressor test, 0.64; CI, 0.47-0.88), adjusted for age and sex. The association was attenuated and borderline significant after multivariable adjustment. The association between unrecognized MI and lower pain sensitivity was stronger in women than in men, and statistically significant in women only, but interaction testing was not statistically significant (P for interaction=0.14).
Our findings suggest that persons who experience unrecognized MI have reduced pain sensitivity compared with persons who experience recognized MI. This may partially explain the lack of symptoms associated with unrecognized MI.
未识别的心肌梗死（MI）是一种常见病症，其死亡风险与已识别的心肌梗死相似。尚不清楚为何有些人发生心肌梗死时症状很少或没有症状；然而，一种可能的解释是疼痛敏感性降低。据我们所知，此前尚无研究探讨疼痛敏感性与心肌梗死识别之间的关联。
我们开展了一项基于人群的横断面研究，纳入4849名参与者，他们接受了冷加压试验（一种常见的实验性疼痛测定法）和心电图检查。387名（8%）参与者存在未识别的心肌梗死，227名（4.7%）参与者存在已识别的心肌梗死。在调整年龄和性别后，未识别心肌梗死的参与者忍受冷加压试验的时间明显长于已识别心肌梗死的参与者（中止冷加压试验的风险比为0.64；CI，0.47 - 0.88）。多变量调整后，该关联减弱且接近显著。未识别的心肌梗死与较低疼痛敏感性之间的关联在女性中比在男性中更强，且仅在女性中具有统计学意义，但交互作用检验无统计学意义（交互作用P值 = 0.14）。
我们的研究结果表明，与已识别心肌梗死的人相比，发生未识别心肌梗死的人疼痛敏感性降低。这可能部分解释了未识别心肌梗死相关症状的缺乏。
