Qin Pei, Nicholl Barbara I, Ho Frederick K, Hanlon Peter, Celis-Morales Carlos A, Pell Jill P
School of Health and Wellbeing, University of Glasgow, Glasgow UK.
Clinical Center for Public Health, Shenzhen Qianhai Free Trade Zone Hospital, Shenzhen, China.
Eur J Prev Cardiol. 2025 Mar 20. doi: 10.1093/eurjpc/zwaf153.
Pain is associated with cardiovascular disease; however, its association with incident arrhythmias is unclear. We assessed associations between different pain characteristics (pain type, chronic pain, chronic widespread pain [chronic widespread pain], chronic musculoskeletal pain [chronic musculoskeletal pain], and number of chronic pain and chronic musculoskeletal pain sites) and incident cardiac arrhythmias, overall and by subtype.
The study included 422,654 UK Biobank participants. Pain was ascertained via a touchscreen questionnaire. The outcomes were incident arrhythmias: all cardiac arrhythmias, atrial fibrillation (AF), other (non-AF) cardiac arrhythmias, bradyarrhythmias, and ventricular arrhythmias. Multivariable Cox-proportional regression was used to investigate the associations.
Over a mean (SD) follow-up of 13.19 (1.96) years, 36,860 (8.72%) participants developed arrhythmia. Compared with those without pain, those with chronic localized pain and chronic widespread pain had increased risk of all cardiac arrhythmias (hazard ratio [HR] 1.13, 95% confidence interval [CI], 1.10-1.17; 1.34, 1.19-1.51), AF (1.09, 1.05-1.14; 1.33, 1.15-1.55), and other cardiac arrhythmias (1.17, 1.12-1.22; 1.41, 1.20-1.66). There was evidence of a dose-relationship between number of chronic pain sites and risk of all cardiac arrhythmias, AF and bradyarrhythmias. Effect estimates were significantly larger among participants aged <60 years than those aged ≥60 years, and larger in women than men.
Chronic pain was associated with cardiac arrhythmias. Whilst causation cannot be assumed in any observational study, there was evidence of both a temporal relationship and dose-relationship. These findings reinforce the need for pain management approaches that include a broad assessment of individuals' risk factors, wider health status, and appropriate vigilance for emerging conditions.
疼痛与心血管疾病相关；然而，其与新发心律失常的关联尚不清楚。我们评估了不同疼痛特征（疼痛类型、慢性疼痛、慢性广泛性疼痛、慢性肌肉骨骼疼痛以及慢性疼痛和慢性肌肉骨骼疼痛部位的数量）与总体及各亚型新发心律失常之间的关联。
该研究纳入了422,654名英国生物银行的参与者。通过触摸屏问卷确定疼痛情况。结局指标为新发心律失常：所有心律失常、心房颤动（AF）、其他（非AF）心律失常、缓慢性心律失常和室性心律失常。采用多变量Cox比例回归分析来研究这些关联。
在平均（标准差）13.19（1.96）年的随访中，36,860名（8.72%）参与者发生了心律失常。与无疼痛者相比，患有慢性局限性疼痛和慢性广泛性疼痛的参与者发生所有心律失常（风险比[HR] 1.13，95%置信区间[CI]，1.10 - 1.17；1.34，1.19 - 1.51）、AF（1.09，1.05 - 1.14；1.33，1.15 - 1.55）以及其他心律失常（1.17，1.12 - 1.22；1.41，1.20 - 1.66）的风险增加。有证据表明慢性疼痛部位数量与所有心律失常、AF和缓慢性心律失常风险之间存在剂量关系。年龄<60岁参与者的效应估计值显著高于年龄≥60岁者，且女性高于男性。
慢性疼痛与心律失常相关。虽然在任何观察性研究中都不能假定因果关系，但存在时间关系和剂量关系的证据。这些发现强化了疼痛管理方法的必要性，该方法应包括对个体风险因素、更广泛的健康状况进行全面评估以及对新出现情况进行适当监测。
