Association between chronic pain and incident cardiovascular disease: a nationwide prospective cohort study from the CHARLS database

Background Chronic pain is highly prevalent among middle-aged and older adults. Growing evidence suggests that chronic pain may be associated with an increased risk of cardiovascular disease (CVD), however, prospective evidence examining the relationship between chronic pain, particularly pain at different anatomical sites and the number of pain locations and incident CVD remains limited. Objective To determine the association between chronic pain, including pain at different anatomical sites and the number of pain locations, and the risk of incident CVD in a middle-aged and older adult population. Methods We used data from the China Health and Retirement Longitudinal Study (CHARLS), a nationally representative longitudinal cohort of middle-aged and older adults in China. Chronic pain and specific pain locations were assessed at baseline, and incident CVD, including heart disease, hypertension, and stroke, was identified during follow-up. Multivariable-adjusted Logistic models were applied to examine the associations between chronic pain status, pain locations, and the risk of incident CVD. Results Among the 11,482 participants included in the present study, 3,665 (31.9%) had chronic pain. During nearly 9 years of follow-up, compared with individuals without chronic pain, those with chronic pain had a higher incidence of heart disease (18.5% vs. 12.4%, p<0.001; adjusted OR=1.61, 95%CI 1.45-1.80, p<0.001), hypertension (31.1% vs. 27.4%, p<0.001; adjusted OR=1.20, 95%CI 1.10-1.31, p<0.001), and stroke (7.7% vs. 4.5%, p<0.001; adjusted OR=1.54, 95%CI 1.19-1.97, p<0.001). Trunk pain was associated with a significantly increased risk of CVD compared with head/neck pain or limb pain. The total number of pain sites was positively associated with the risk of incident CVD (p for trend <0.001). Across different subgroups, chronic pain consistently and significantly increased the risk of CVD (all p for interaction>0.05). Conclusion The prevalence of chronic pain is high among middle-aged and older adults and is significantly associated with an increased risk of incident CVD. A risk gradient was observed across different pain locations, with trunk pain showing the strongest association with CVD. In addition, the number of pain sites was significantly positively correlated with the occurrence of CVD. These findings underscore the importance of incorporating cardiovascular risk assessment and comprehensive intervention strategies into the management of chronic pain, thereby providing a new perspective for the prevention of cardiovascular events.