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Assessment of endothelial function in patients with fibromyalgia—cardiac ultrasound study

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Abstract

In patients with fibromyalgia (FM) syndrome, stress and pain may chronically enhance sympathetic activity, altering cardiovascular response and inducing endothelial dysfunction. We investigated endothelial function in FM patients using echocardiography and analyzed whether endothelial function was affected by the clinical parameters of FM. Fifty-five postmenopausal women with FM and 35 healthy controls were included. Endothelial function was examined by brachial artery flow-mediated dilatation (FMD, endothelium dependent) and response to 40 μg of sublingual nitroglycerine (NTG-induced dilatation, endothelium independent). FM patients underwent manual tender point survey and completed visual analogue scale (VAS) of pain and fibromyalgia impact questionnaire (FIQ). The study participants were subdivided into two groups based on the sum of the FIQ score (group A, FIQ ≥ 50, group B, <50). The FMD value (5.7 ± 3.9% vs. 7.0 ± 1.4%, P = 0.008) and NTG-induced dilatation (12.5 ± 5.1% vs. 14.7 ± 2.5%, P = 0.006) were significantly lower in FM group than healthy control. There were no significant differences in FMD between groups A and B (5.4 ± 3.3% vs. 6.6 ± 3.5%, P = 0.19). However, significant decreases were noted in NTG-induced dilatation values of group A compared with those of group B (11.0 ± 4.4% vs. 14.3 ± 3.8%, P = 0.004). FMD and NTG-induced dilatation showed a significant inverse association with pain VAS and FIQ. Pain exerts a negative effect on endothelial function in FM patients, and that effect was significantly different according to the FIQ score.

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References

  1. Lawrence RC, Felson DT, Helmick CG et al (2008) National arthritis data workgroup. Estimates of the prevalence of arthritis and other rheumatic conditions in the United States. Part II. Arthritis Rheum 58:26–35

    Article  PubMed  Google Scholar 

  2. Gormsen L, Rosenberg R, Bach FW et al (2010) Depression, anxiety, health-related quality of life and pain in patients with chronic fibromyalgia and neuropathic pain. Eur J Pain 14(127):1–8

    Google Scholar 

  3. Bigatti SM, Hernandez AM, Cronan TA et al (2008) Sleep disturbances in fibromyalgia syndrome: relationship to pain and depression. Arthritis Rheum 59:961–967

    Article  PubMed  Google Scholar 

  4. Aronoff GM (1998) Myofascial pain syndrome and fibromyalgia: a critical assessment and alternate view. Clin J Pain 14:74–85

    Article  PubMed  CAS  Google Scholar 

  5. Aaron LA, Bradley LA, Alarcón GS et al (1997) Perceived physical and emotional trauma as precipitating events in fibromyalgia. Associations with health care seeking and disability status but not pain severity. Arthritis Rheum 40:453–460

    Article  PubMed  CAS  Google Scholar 

  6. Walker EA, Keegan D, Gardner G et al (1997) Psychosocial factors in fibromyalgia compared with rheumatoid arthritis: II. Sexual, physical, and emotional abuse and neglect. Psychosom Med 59:572–577

    PubMed  CAS  Google Scholar 

  7. Grippo AJ, Johnson AK (2009) Stress, depression and cardiovascular dysregulation: a review of neurobiological mechanisms and the integration of research from preclinical disease models. Stress 12:1–21

    Article  PubMed  CAS  Google Scholar 

  8. McEwen BS (1998) Protective and damaging effects of stress mediators. N Engl J Med 338:171–179

    Article  PubMed  CAS  Google Scholar 

  9. Rozanski A, Blumenthal JA, Kaplan J (1999) Impact of psychological factors on the pathogenesis of cardiovascular disease and implications for therapy. Circulation 99:2192–2217

    PubMed  CAS  Google Scholar 

  10. Rozanski A, Blumenthal JA, Davidson KW et al (2005) The epidemiology, pathophysiology, and management of psychosocial risk factors in cardiac practice: the emerging field of behavioral cardiology. J Am Coll Cardiol 45:637–651

    Article  PubMed  Google Scholar 

  11. Tofler GH, Muller JE (2006) Triggering of acute cardiovascular disease and potential preventive strategies. Circulation 114:1863–1872

    Article  PubMed  Google Scholar 

  12. Mittleman MA, Maclure M, Sherwood JB et al (1995) Triggering of acute myocardial infarction onset by episodes of anger: determinants of Myocardial Infarction Onset Study Investigators. Circulation 92:1720–1725

    PubMed  CAS  Google Scholar 

  13. Leor J, Poole WK, Kloner RA (1996) Sudden cardiac death triggered by an earthquake. N Engl J Med 334:413–419

    Article  PubMed  CAS  Google Scholar 

  14. Ghiadoni L, Donald AE, Cropley M et al (2000) Mental stress induces transient endothelial dysfunction in humans. Circulation 102:2473–2478

    PubMed  CAS  Google Scholar 

  15. Spieker LE, Hürlimann D, Ruschitzka F et al (2002) Mental stress induces prolonged endothelial dysfunction via endothelin-A receptors. Circulation 105:2817–2820

    Article  PubMed  CAS  Google Scholar 

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

    PubMed  CAS  Google Scholar 

  17. Marwah RS, Doux JD, Lee PY et al (2007) Is atherosclerosis a neurogenic phenomenon? Med Hypotheses 69:884–887

    Article  PubMed  CAS  Google Scholar 

  18. Dekker JM, Crow RS, Folsom AR et al (2000) Low heart rate variability in a 2-minute rhythm strip predicts risk of coronary heart disease and mortality from several causes: the ARIC study. Atherosclerosis risk in communities. Circulation 102:1239–1244

    PubMed  CAS  Google Scholar 

  19. Pauletto P, Scannapieco G, Pessina AC (1991) Sympathetic drive and vascular damage in hypertension and atherosclerosis. Hypertension 17(4 Suppl):III75–III81

    PubMed  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  21. Gottdiener JS, Kop WJ, Hausner E et al (2003) Effects of mental stress on flow-mediated brachial arterial dilation and influence of behavioral factors and hypercholesterolemia in subjects without cardiovascular disease. Am J Cardiol 92:687–691

    Article  PubMed  Google Scholar 

  22. Celermajer DS, Sorensen KE, Gooch VM et al (1992) Non-invasive detection of endothelial dysfunction in children and adults at risk of atherosclerosis. Lancet 340:1111–1115

    Article  PubMed  CAS  Google Scholar 

  23. Cohn JN, Quyyumi AA, Hollenberg NK et al (2004) Surrogate markers for cardiovascular disease: functional markers. Circulation 109(25 Suppl 1):IV31–IV46

    PubMed  Google Scholar 

  24. Oliver JJ, Webb DJ (2003) Noninvasive assessment of arterial stiffness and risk of atherosclerotic events. Arterioscler Thromb Vasc Biol 23:554–566

    Article  PubMed  CAS  Google Scholar 

  25. O'Leary DH, Polak JF (2002) Intima-media thickness: a tool for atherosclerosis imaging and event prediction. Am J Cardiol 90:18–21

    Article  Google Scholar 

  26. Celermajer DS, Sorensen KE, Bull C et al (1994) Endothelium-dependent dilation in the systemic arteries of asymptomatic subjects relates to coronary risk factors and their interaction. J Am Coll Cardiol 24:1468–1474

    Article  PubMed  CAS  Google Scholar 

  27. Wolfe F, Smythe HA, Yunus MB et al (1990) The American College of Rheumatology 1990 criteria for the classification of fibromyalgia. Report of the multicenter criteria committee. Arthritis Rheum 33:160–172

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  Google Scholar 

  29. Abeles M, Solitar BM, Pillinger MH et al (2008) Update on fibromyalgia therapy. Am J Med 121:555–561

    Article  PubMed  CAS  Google Scholar 

  30. Corretti MC, Anderson TJ, Benjamin EJ et al (2002) Guidelines for the ultrasound assessment of endothelial-dependent flow-mediated vasodilation of the brachial artery: a report of the international brachial artery reactivity task force. J Am Coll Cardiol 39:257–265

    Article  PubMed  Google Scholar 

  31. Adams MR, Robinson J, McCredie R et al (1998) Smooth muscle dysfunction occurs independently of impaired endothelium-dependent dilation in adults at risk of atherosclerosis. J Am Coll Cardiol 32:123–127

    Article  PubMed  CAS  Google Scholar 

  32. Lee RT, Kamm RD (1994) Vascular mechanics for the cardiologist. J Am Coll Cardiol 23:1289–1295

    Article  PubMed  CAS  Google Scholar 

  33. Gibbons GH, Dzau VJ (1994) The emerging concept of vascular remodeling. N Engl J Med 330:1431–1438

    Article  PubMed  CAS  Google Scholar 

  34. Cho KI, Lee JH, Kim SM et al (2010) Assessment of myocardial function in patients with fibromyalgia and the relation to chronic emotional and physical stress. Korean Circ J 40(2):74–80

    Article  PubMed  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

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

    PubMed  CAS  Google Scholar 

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

    PubMed  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  39. Cooper DC (2010) Adverse impact of mood on flow-mediated dilation. Psychosom Med 72(2):122–127

    Article  PubMed  Google Scholar 

Download references

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Cho, K.I., Lee, J.H., Kim, S.M. et al. Assessment of endothelial function in patients with fibromyalgia—cardiac ultrasound study. Clin Rheumatol 30, 647–654 (2011). https://doi.org/10.1007/s10067-010-1599-8

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  • DOI: https://doi.org/10.1007/s10067-010-1599-8

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