Association between chronic fatigue syndrome/myalgic encephalomyelitis and cardiovascular disease, 2025, Denu+

Nightsong

Nightsong

Senior Member (Voting Rights)
Abstract:
Chronic fatigue syndrome or myalgic encephalomyelitis (CFS/ME) is a medical condition characterized by severe and prolonged fatigue that is not relieved by rest or attributed to any underlying medical or psychological condition. Individuals with CFS/ME are considered to have an increased risk of a wide range of comorbid conditions, including cardiovascular disease (CVD). The association between CFS/ME and CVD is not fully understood.

To determine the prevalence of CFS/ME in a sample population and examine its association with CVD. Weighted sample size data of 114,834 was analyzed from the 2021–2022 national health interview survey (NHIS). Information on sociodemographic factors, CVD risk factors, and history of CFS/ME and CVD were collected. Multivariable logistic regression model was used to determine the association between CFS/ME and CVD, adjusting for traditional CVD risk factors (age, sex, race, hypertension, diabetes, dyslipidemia, smoking, and body mass index (BMI). Median age of participants was 53 years, and majority of participants were female (53.9%). Prevalence of CFS/ME was 1.2%.

A history of CFS/ME was significantly associated with CVD (aOR 3.26, 95%CI 2.85, 3.72, p-value: <0.001) after adjusting for traditional CVD risk factors. A history of CFS/ME was independently associated with CVD after adjusting for traditional CVD risk factors. Patients with CFS/ME need close evaluation for CVD. Further studies are needed to better understand the relationship between CFS/ME and CVD.

Link | PDF (Nature Scientific Reports, January 2025, open access)
 
decreased physical activity and lack of adherence to medical treatments may be potential mediators of the association seen from our analysis.
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I can’t tell if “lack of adherence to medical treatments” refers to the fact we have worse access to healthcare, or the bigoted “you don’t want to get better”, difficult patient, stereotypes.
 
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Utsikt said:
Too wide definitions?
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Yeah this will include loads of “idiopathic chronic fatigue” cases
A history of chronic fatigue syndrome was derived from a “Yes” response to the question, “Have you ever been told by a doctor or other healthcare professional that you had chronic fatigue syndrome (CFS/ME) or myalgia encephalomyelitis (ME)?”
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It's pretty good quality data, as far as anything to do with ME/CFS goes.

US NHIS data
Data from the 2021–2022 national health interview survey (NHIS) was utilized for this study. The NHIS is an annual cross-sectional household survey by the national center for health statistics (NCHS) of the center for disease control and prevention (CDC). The NHIS has been conducted continuously since 1957, and it is a principal source of health information on the civilian non-institutionalized population. The NHIS is a household survey across all the states in the United States. Using telephone interviews due to the COVID-19 pandemic, the NHIS employed geographically clustered sampling techniques to be nationally representative.
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Heart disease
The primary outcome was a self-reported history of cardiovascular disease: Coronary heart disease, Angina, Myocardial infarction, and Stroke. These were accessed by respondents’ responses to the questions “Have you ever been told by a doctor or other healthcare professional that you had coronary heart disease?”, “Have you ever been told by a doctor or other healthcare professional that you had angina, also known as angina pectoris?”, “Have you ever been told by a doctor or other healthcare professional that you had a heart attack, also known as myocardial infarction?” and “Have you ever been told by a doctor or other healthcare professional that you had a stroke?”.
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CFS
history of chronic fatigue syndrome was derived from a “Yes” response to the question, “Have you ever been told by a doctor or other healthcare professional that you had chronic fatigue syndrome (CFS/ME) or myalgia encephalomyelitis (ME)?”
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I think ME/CFS advocates campaigned to get ME/CFS into the NHIS survey, so their efforts are bearing fruit. Has there been a separate paper on (ME/)CFS prevalence as estimated by this survey?
 
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After adjusting for CVD risk factors using the multivariable logistic regression model, CFS/ME was significantly associated with CVD. Study participants diagnosed with CFS/ME had over a three-fold increase in the odds of cardiovascular disease (aOR 3.26 95% CI 2.85,3.72).p-value < 0.001). This indicates that chronic fatigue syndrome remained a significant independent risk factor for cardiovascular disease after adjusting for age, sex, race, diabetes, hypertension, dyslipidemia, BMI category, and smoking status. Since our study examined associations, reverse causality between CFS/ME and CVD may explain some of our findings given as CFS/ME is commonly misdiagnosed30. For BMI, we observed a stronger association for the underweight category. Many secondary associations of CFS/ME including depression, physical disability, mobility impairment and decreased physical activity and lack of adherence to medical treatments may be potential mediators of the association seen from our analysis31–35.
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The fact that there was still a strong relationship in the underweight category suggests that there might be some real association, separate from the confounding. That adjusted Odds ratio of 3.26 is a substantial increase in risk.

From our analysis, a history of CFS/ME was an independent risk factor for cardiovascular disease, after adjusting for other well identified risk factors. Our findings mirror that from some previous studies on association between CFS and CVS, but the magnitude of our estimates are much higher than those reported by Basu et al. from their cohort study36. Other studies show other forms of significant cardiac dysfunction in CFS/ ME37,38. With this observation of the association between CFS/ME and CVD, further attention to identifying and managing other CVD risk factors among patients with CFS/ME is ever more essential.
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A large prospective cohort study would be helpful in further understanding the complexity of the association observed. This is particularly important as there is an increase in the prevalence of both CFS/ME and CVD post-COVID-19 pandemic39,40.
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The authors are good at acknowledging all the uncertainties with their findings.
 
Hutan said:
I think ME/CFS advocates campaigned to get ME/CFS into the NHIS survey, so their efforts are bearing fruit.
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Hutan said:
The authors are good at acknowledging all the uncertainties with their findings.
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It’s better than nothing, and the phrasing makes it so that the source of bias is consistent if anything.

The underlying problem is lack of knowledge of ME/CFS and therefore both under- and over-use of the diagnosis. Good that they are aware of this.

Is depression commonly associated with ME/CFS?
 
Unfortunately pay-walled:

NEJM Journal Watch General Medicine for February 20, 2025

SUMMARY AND COMMENT

Association Between ME/CFS and Cardiovascular Disease
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Anthony L. Komaroff, MD, reviewing Denu MKI et al. Sci Rep 2025 Jan 17

http://www.jwatch.org/NA58463
 
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