There is a lot of talk and writing about the brains and nerves of people with fibromyalgia, also about hormones, the immune system, and digestive problems.
What you don’t hear much of is from the heart, and that must change.
Researchers have discovered information about heart disease and fibromyalgia heart abnormalities that we all need to know and that our doctors need to know too.
Fibromyalgia and heart disease
First, a reminder: just because there is an increased risk of having a health problem does not mean that you will develop it. Knowing your risk is a good thing because it gives you the opportunity to make healthy changes.
Research suggests that women with fibromyalgia have a higher risk of heart disease than healthy women. That was one of the findings of the well-known al-Andalus project, published in the journal Clinical and Experimental Rheumatology.
Spanish researchers conducted a study documenting risk factors for cardiovascular disease, including:
♣ Waist circumference
♣ Body fat percentage
♣ Resting heart rate
♣ Blood pressure
♣ Cardiorespiratory fitness
♣ Cigarettes smoked per day
When comparing the two groups, they found that women in the fibromyalgia group:
♦ They had a greater waist circumference
♦ They had more body fat
♦ Smoked more cigarettes
♦ Had lower levels of cardiorespiratory fitness
Being overweight and out of shape is a logical consequence of a chronic illness, especially when your illness makes physical exertion extremely difficult on your body. When moving causes pain, people tend to move less.
They also found that fibromyalgia participants who exercised less had higher risk factors than those who engaged in moderate to vigorous physical activity.
Heart failure in fibromyalgia
A 2017 study suggests that fibromyalgia is especially common in people with chronic heart failure (CHF). Furthermore, fibromyalgia was associated with worse outcomes in CHF.
Of the 57 people with CHF who were studied, 13 met the diagnostic criteria for fibromyalgia. That’s almost 23 percent, which is considerably higher than the rate in the general population, which is estimated to be between three and six percent.
People with fibromyalgia were also more likely to have other central sensitivity syndromes, especially Temporomandibular joint disorder, headache, and irritable bladder.
Beyond weight and fitness
Is our increased risk of heart disease entirely attributable to our weight and fitness levels? Probably not. Research has also found fibromyalgia-related heart abnormalities that have nothing to do with them.
An exercise study detailing several abnormalities in the fibromyalgia group, including:
• Delayed recovery of heart rate
• Chronotropic incompetence
It’s worth noting that in this study, disease and control groups matched body mass index and age, so participants with fibromyalgia were no more overweight than healthy women.
“Chronotropic incompetence” means that the heart cannot increase its rate enough to cope with the demands of activity. It is known to cause exercise intolerance and is common in people with cardiovascular disease.
Exercise intolerance has long been a known feature of fibromyalgia, and this could help explain why.
This should offer some vindication to many people with this condition who have been told they just need to “exercise more” and will be fine, by people who do not understand (or refuse to consider) that more exercise means more severe symptoms.
The autonomic nervous system is believed to be dysregulated in fibromyalgia. It controls many automatic functions in your body, including heart rate and blood pressure. This study appears to provide additional evidence to support that hypothesis.
Those researchers looked at the fluctuations in the heartbeat of people with fibromyalgia, involving all those jagged lines you see on a heart monitor. Each peak and valley, and the distances between them, can tell an expert a lot about your heart health.
They found patterns that were abnormal and distinct from those of healthy subjects, again suggesting problems with the autonomic nervous system and its control of heart rate.
Problems with something called baroreflex have also been linked to fibromyalgia. Baroreflex helps your body with homeostasis, which is what keeps things like internal temperature in balance. Specifically, the baroreflex is part of what keeps your blood pressure at a near constant level.
The cardiac baroreflex was found to have a lower involvement during an active status test in people with fibromyalgia than in healthy controls. In addition to that, the lower the baroreflex involvement, the more severe the fibromyalgia case.
One study found that fibromyalgia was especially prevalent in people who complained of heart palpitations (rapid heartbeats).
The heart rate response during exercise in fibromyalgia was analyzed and found no difference between the disease and the control groups with low-level exercise. However, at higher levels, participants with fibromyalgia had a harder time reaching peak oxygen uptake, perhaps due to abnormal metabolic responses.
Some treatments are being investigated for some of the specific heart abnormalities related to fibromyalgia.
The effects of slow breathing in fibromyalgia have been examined because it has been shown to be effective in moderating symptoms, but we don’t yet know why. During normal breathing, compared to controls, the fibromyalgia group showed differences in heart rate, the variability of heart rate.
Interestingly, the fibromyalgia participants showed improved autonomic function during slow breathing and even greater improvement with mechanically assisted respiration. The researchers urged more research on the nervous system’s involvement with the changes, as well as whether training fibromyalgia patients on fast breathing can replicate the results they had with mechanical assistance.
They also investigated whether something called Systolic Extinction Training (SES) was an effective treatment for people with fibromyalgia who show an elevated blood pressure response to stress.
This training combines environmental, lifestyle, and behavioral changes with BaroReflex training, a type of electrical stimulation delivered at precise points in the cardiac cycle. They compared EES with treatment with electrical stimulation that was not related to the cardiac cycle, and also with aerobic exercise.
They reported that the EES caused significant and long-lasting pain remission and was more effective than the other treatments. This was a small study, so it cannot be taken as strong evidence, but it could lead to more studies in the future.
Moderating your risk
If you are concerned about these risk factors, talk to your doctor about them and try making slow, gradual changes rather than jumping to a new diet and exercise regimen. Our bodies do not react well to sudden and extreme changes.
Conventional wisdom tells us that we can improve our heart health by eating certain foods, losing weight, and exercising. Because you have fibromyalgia, some of those things are likely to be more difficult for you than for most people, although losing weight can also help relieve fibromyalgia symptoms.
If we are careful, most of us can gradually increase our activity levels, but it all depends on how we approach it. Many people with fibromyalgia benefit from gentle exercises such as yoga, Tai Chi, Qigong, and warm water exercises.
If you smoke, quitting can improve your heart health and also
it can help decrease your fibromyalgia symptoms.