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Chronic pain, body mass index and cardiovascular disease risk factors: tests of moderation, unique and shared relationships in the Study of Women’s Health Across the Nation (SWAN)

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Abstract

Chronic pain may be related to cardiovascular disease (CVD) risk. The current study examined whether persistent bodily pain was related to cardiovascular disease risk factors, whether these effects were moderated by body mass index (BMI), and, if not, whether chronic pain accounted for unique variance in CVD risk factors. Participants were women (N = 2,135) in the Study of Women’s Health Across the Nation. A high pain frequency variable (high pain in 0 through 4 assessments) was coded to reflect the frequency of high levels of bodily pain across the first 3 years of the study. Six CVD risk factors and BMI were measured at follow-up year 3. High pain frequency and BMI were correlated significantly with risk factors, although effects for the former were small. Hierarchical multiple regressions revealed high pain frequency × BMI interactions for 5 of 6 CVD risk factors. Dissecting the interactions revealed a similar pattern across 4 risk factors: for women with normal BMI, there was a “dose–response” in which increasing frequency of high pain revealed increasingly worse CVD risk factor levels, whereas for women with obese BMI, high pain frequency was unrelated to risk factors. For obese women, increasing frequency of high pain was associated with higher blood glucose. Although BMI is a well-established CVD risk factor, evaluation of CVD risk level may be improved by considering the incidence of persistent pain, particularly in normal weight women (BMI < 25 kg/m2) lower BMI.

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Acknowledgments

The data used in this study are derived from The Study of Women’s Health Across the Nation (SWAN). Grant support for SWAN is from the National Institutes of Health (NIH), DHHS, through the National Institute on Aging (NIA), the National Institute of Nursing Research (NINR) and the NIH Office of Research on Women’s Health (ORWH) (Grants U01NR004061; U01AG012505, U01AG012535, U01AG012531, U01AG012539, U01AG012546, U01AG012553, U01AG012554, U01AG012495). The content of this manuscript is solely the responsibility of the authors and does not necessarily represent the official views of the NIA, NINR, ORWH or the NIH. The opinions or assertions contained herein are the private views of the authors, and are not to be construed as official, or as reflecting true views, of the Department of the Army or the Department of Defense.

Conflict of interest

John W. Burns, Phillip J. Quartana, Stephen Bruehl, Imke Janssen, Sheila A. Dugan, Bradley Appelhans, Karen A. Matthews, and Howard M. Kravitz declared that they have no conflict of interest.

Human and animal rights and Informed Consent

All procedures followed were in accordance with ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000. Informed consent was obtained from all patients for being included in the study.

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Authors and Affiliations

  1. Department of Behavioral Sciences, Rush University Medical Center, 1645 W Jackson Blvd., Chicago, IL, 60612, USA

    John W. Burns, Imke Janssen, Sheila A. Dugan, Bradley Appelhans & Howard M. Kravitz

  2. Walter Reed Army Institute of Research, Silver Spring, MD, USA

    Phillip J. Quartana

  3. Vanderbilt University Medical Center, Nashville, TN, USA

    Stephen Bruehl

  4. University of Pittsburgh School of Medicine, Pittsburgh, PA, USA

    Karen A. Matthews

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Burns, J.W., Quartana, P.J., Bruehl, S. et al. Chronic pain, body mass index and cardiovascular disease risk factors: tests of moderation, unique and shared relationships in the Study of Women’s Health Across the Nation (SWAN). J Behav Med 38, 372–383 (2015). https://doi.org/10.1007/s10865-014-9608-z

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