Musculoskeletal pain and atrial fibrillation: the Framingham Heart Study

Given the morbidity and mortality of atrial fibrillation (AF), identifying factors associated with its onset is a priority. Chronic pain affects one-third of Americans and is linked to cardiovascular disease outcomes, including stroke and mortality. Since there are common pathophysiological mechanisms, including inflammation and oxidative stress, we sought to investigate whether musculoskeletal pain, including widespread pain (WSP), was associated with AF. Participants aged ≥ 45 years from the Framingham Heart Study (FHS) Original and Offspring cohorts who completed a pain assessment were included. Pain was categorized into three groups: widespread pain (WSP), non-widespread pain (non-WSP), and no pain. Incident AF was identified using ECGs and medical records. We assessed the relation of pain and risk of incident AF using Fine-Gray subdistribution hazard modeling accounting for competing risk of death. Models were adjusted for potential confounders. The incident AF analysis included 3,740 participants ( N = 358 AF events). Mean age at pain assessment was 62 ± 11 years and 56% were women. Compared to those with no pain, the risk for incident AF was modestly elevated among those with non-WSP (sHR = 1.30 (95% CI: 1.03–1.64); p = 0.03) and WSP (sHR = 1.41 (95% CI: 1.01–1.98); p = 0.04) in age/sex-adjusted models. The association was attenuated after multivariable adjustment (sHR non-WSP = 1.26 (95% CI: 1.00-1.59; p = 0.05) and sHR WSP = 1.35 (95% CI: 0.96–1.88; p = 0.08). We observed a modest association between musculoskeletal pain (WSP and non-WSP) and 10-year incident AF in age and sex-adjusted models that accounted for the competing risk mortality, however, this finding did not attain statistical significance after adjustment for the CHARGE-AF 1 risk factor score components in the multivariable model.