Synergistic effects of chronic pain and diabetes on cardiovascular disease risk: findings from a nationwide cohort study

BACKGROUND: Chronic pain is a significant risk factor for cardiovascular diseases (CVD). However, the impact of dynamic changes in pain site count and the interaction between pain and diabetes on CVD risk remain unclear. METHODS: The study was a prospective cohort analysis based on data from the China Health and Retirement Longitudinal Study (CHARLS, 2011-2020). Participants aged ≥ 45 years with follow-up data on pain, diabetes, and cardiovascular disease (CVD) were included, excluding those with CVD at baseline. Pain sites and counts were categorized, and changes in pain site count across waves 1 to 3 were assessed, dividing participants into four groups: Cluster 1 (n = 6477) with persistently low counts; Cluster 2 (n = 964) with a significant increase; Cluster 3 (n = 272) with consistently high counts; and Cluster 4 (n = 680) with a significant decrease. CVD was defined as self-reported physician-diagnosed heart disease (including myocardial infarction, angina, coronary heart disease, heart failure, or other heart problems) and stroke. Cox regression was used to assess the relationship between pain and CVD, and an additive interaction analysis evaluated the interaction between pain and diabetes. RESULTS: 13,492 participants were enrolled. With a median follow-up of 9 years, 3,146 participants (23.32%) developed incident CVD. Cox regression showed that pain was associated with a 28% higher risk of CVD (HR 1.28, 95% CI 1.18-1.41). When pain affected more than six sites, CVD risk increased by 64% (HR 1.64, 95% CI 1.44-1.87). Participants with consistently high pain site count had the highest CVD risk compared to those with consistently low count (HR 1.94, 95% CI 1.53-2.46), while those with a decreasing trend in pain site count had a lower risk (HR 1.49, 95% CI 1.26-1.78). Interaction analysis revealed a significant interaction between pain and diabetes in predicting CVD, contributing an additional 35% risk (RERI 0.35, AP 0.2, S 1.9). CONCLUSIONS: The number of pain sites and its dynamic changes are closely associated with CVD risk, and the synergistic effect of pain and diabetes requires more attention.