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Is Heart Disease in ME/CFS and FM Patients’ Future?

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Reprinted with the kind permission of Cort Johnson and Health Rising.

Coronary heart disease (CHD) occurs when plaque builds up on the arteries that supply blood to the heart. The plaque build up can reduce blood flows to the heart causing chest pain – particularly during strenuous activity. If the plaque bursts, a clot can form which can block blood flows to the heart causing a heart attack.

CHD is the leading cause of death in the U.S. Despite the fact that it typically shows up about ten years later in women than men, it is the leading cause of death in the U.S. for women. This is the second Taiwanese study to find an increased risk of CHD in people with fibromyalgia (almost 50%). The increased risk of CHD in people with fibromyalgia was not as high as for diabetes or hypertension and was described as “moderate.”

FM patients with diabetes, hypertension, hyperlipidemia, congestive heart failure, cerebral vascular diseases, depression or anxiety had more significantly increased risks of CHD. Interestingly, the risk for CHD was higher in FM patients without depression than in those with depression but not FM.

The authors proposed several hypotheses to explain the increased CHD. They rejected the idea that the high use of NSAIDS, antidepressants and pain killers were contributing to it. Instead, they suggested that chronic stress, including in some patients early lifetime stressors, increased sympathetic nervous system activity and reduced parasympathetic nervous system activity. They noted the reduced heart variability results found in FM, which are a known risk factor for heart disease.

People with chronic fatigue syndrome should note that similar autonomic nervous system findings are found in ME/CFS.

Several studies have found “unfavorable lipid profiles” that could increase the risk of atherosclerosis in ME/CFS. A small 2012 study of women with ME/CFS found high triglyceride and malondialdehyde levels and low levels of the healthy cholesterol (HDL-C). HDL-C is an anti-inflammatory agent that prevents cholesterol accumulations on the cell walls and reduces lipid peroxidation.

The authors proposed that these factors may predispose ME/CFS patients to vascular (blood vessel) damage and suggested antioxidant supplement and LDL lowering strategies be employed. A 2005 study found increased levels of oxidized lipids and decreased HDL-C in ME/CFS patients with risk factors (high blood pressure and/or obesity).

High levels of overweight and obesity in fibromyalgia may contribute to the problem although they may not be higher than in the population at large. One study suggested that negative lipid profiles in FM were associated with increased weight – suggesting one possible way to reduce them.

Risk Factors for CHD

A look at the risk factors for CHD finds a mixed bag for people with ME/CFS/FM. Some are probably high (triglycerides, lack of physical activity, sleep apnea, stress) while some major ones (unhealthy diet, smoking, alcohol consumption, high blood pressure) are perhaps low.

  • High blood cholesterol and triglyceride (tri-GLIS-er-ide) levels (a type of fat found in the blood)
  • High blood pressure
  • Diabetes and prediabetes
  • Overweight and obesity
  • Smoking
  • Lack of physical activity
  • Unhealthy diet
  • Sleep apnea.
  • Stress.
  • Preeclampsia (pre-e-KLAMP-se-ah)

Reduced Physical Activity

Reduced physical activity is an important risk factor, but the authors of the paper did not suggest it was a factor. The US Guidelines for the amount of aerobic exercise needed to maintain health and ward off illness, however, are probably rarely met by people with fibromyalgia and almost never by people with ME/CFS.

The U.S. breaks activity levels into four categories:

  • Inactive is no activity beyond baseline activities of daily living.
  • Low activity is activity beyond baseline but fewer than 150 minutes (2 hours and 30 minutes) of moderate-intensity physical activity a week or the equivalent amount (75 minutes or 1 hour and 15 minutes) of vigorous-intensity activity.
  • Medium activity is 150 minutes to 300 (5 hours) minutes of moderate-intensity activity a week (or 75 to 150 minutes of vigorous-intensity physical activity a week). In scientific terms, this range is approximately equivalent to 500 to 1,000 metabolic equivalent (MET) minutes a week.
  • High activity is more than the equivalent of 300 minutes of moderate-intensity physical activity a week.

Aerobic Activity

The U.S. Guidelines state the following amounts of aerobic activity are needed to maintain health and ward off illness. Moderate (such as brisk walking or tennis) or intense (jogging or swimming) should be done in episodes of at least 10 minutes and, if possible, spread out through the week.

  • 150 minutes (2 hours and 30 minutes) each week of moderate-intensity aerobic physical activity (such as brisk walking or tennis)
  • 75 minutes (1 hour and 15 minutes) each week of vigorous-intensity aerobic physical activity (such as jogging or swimming laps)
  • An equivalent combination of moderate- and vigorous-intensity aerobic physical activity

For even greater health benefits, they recommend

  • Increase moderate-intensity aerobic physical activity to 300 minutes (5 hours) each week
  • Increase vigorous-intensity aerobic physical activity for 150 minutes (2 hours and 30 minutes) each week

Is Coronary Heart Disease in ME/CFS and FM Patients’ Future?

Despite some negative risk factors – not necessarily. The CDC estimates that about 7% of the entire population and about 17% of people over 65 have CHD. Women have lower rates of CHD (@ 5%) than men but may be more severely affected by it when it does occur.

That suggests that even a 50% increase in the risk factor for CHD would leave the vast majority of middle-aged women with FM (>90%) without it. FM and ME/CFS patients with increased risk factors (depression, anxiety, obesity, increased blood pressure, sleep apnea) would have a higher incidence.

Coronary heart disease is something to think about given the reports of decreased heart rate variability, increased oxidative stress, the high triglyceride findings, the lack of activity, etc. in ME/CFS/FM, but it’s certainly not a forgone outcome. More study is clearly needed regarding the long-term effects of these diseases.

In the meantime a heart healthy diet, stress reduction, whatever exercise can be done, strategies to reduce inflammation and sleep studies to assess sleep apnea are probably good ideas.

About the Author: Cort Johnson has had ME/CFS for over 30 years. The founder of Phoenix Rising and Health Rising, Cort has contributed hundreds of blogs on chronic fatigue syndrome, fibromyalgia and their allied disorders over the past 10 years. Find more of Cort’s and other bloggers’ work at Health Rising.

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