Fibromyalgia as an independent risk factor for takotsubo cardiomyopathy: a national inpatient sample case-control study

Aim: Takotsubo cardiomyopathy (TTC) is an acute form of systolic dysfunction triggered by physical or emotional stress, most commonly seen in postmenopausal women. Its pathophysiology involves catecholamine surge, autonomic imbalance, and microvascular dysfunction. Fibromyalgia is a chronic pain disorder observed primarily in premenopausal women characterized by autonomic dysregulation, central sensitization, and high psychiatric comorbidity—mechanisms that overlap substantially with TTC. Nevertheless, fibromyalgia has not been established as an independent risk factor for TTC. This study evaluated the association between fibromyalgia and TTC using a nationally representative sample. Methods: A retrospective case-control study was conducted using the 2022 National Inpatient Sample. Adult hospitalizations with TTC (ICD-10-CM I51.81) were identified, and a 1% random sample of non-TTC admissions served as controls. Fibromyalgia was defined by ICD-10 code M79.7. Survey-weighted multivariable logistic regression assessed the association between fibromyalgia and TTC, adjusting for demographics, comorbidities, and severity of illness. Results: Among 9,376 TTC and 65,690 control hospitalizations, fibromyalgia was present in 282 (3.0%) TTC cases and 827 (1.3%) controls. After multivariable adjustment, fibromyalgia was independently associated with TTC (OR 1.19; 95% CI 1.00–1.42, P = 0.044). This association persisted after accounting for psychiatric comorbidities. Conclusions: Fibromyalgia was associated with increased odds of TTC. These findings highlight the need for vigilance in evaluating fibromyalgia patients with chest pain and warrant further research into mechanisms underlying stress-induced cardiomyopathy.