Low Pain Tolerance Is Associated With Coronary Angiography, Coronary Artery Disease, and Mortality: The Tromsø Study

Background The initial presentation to coronary angiography and extent of coronary artery disease (CAD) vary greatly among patients, from ischemia with no obstructive CAD to myocardial infarction with 3‐vessel disease. Pain tolerance has been suggested as a potential mechanism for the variation in p...

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Autores principales:	Kristina Fladseth, Haakon Lindekleiv, Christopher Nielsen, Andrea Øhrn, Andreas Kristensen, Jan Mannsverk, Maja‐Lisa Løchen, Inger Njølstad, Tom Wilsgaard, Ellisiv B Mathiesen, Audun Stubhaug, Thor Trovik, Svein Rotevatn, Signe Forsdahl, Henrik Schirmer
Formato:	article
Lenguaje:	EN
Publicado:	Wiley 2021
Materias:	coronary angiography coronary artery disease heart disease risk factors microvascular angina pain measurement Diseases of the circulatory (Cardiovascular) system RC666-701
Acceso en línea:	https://doaj.org/article/5ec09a91c835480a9e34ff430d4aa65c
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spelling	oai:doaj.org-article:5ec09a91c835480a9e34ff430d4aa65c2021-11-16T10:22:43ZLow Pain Tolerance Is Associated With Coronary Angiography, Coronary Artery Disease, and Mortality: The Tromsø Study10.1161/JAHA.121.0212912047-9980https://doaj.org/article/5ec09a91c835480a9e34ff430d4aa65c2021-11-01T00:00:00Zhttps://www.ahajournals.org/doi/10.1161/JAHA.121.021291https://doaj.org/toc/2047-9980Background The initial presentation to coronary angiography and extent of coronary artery disease (CAD) vary greatly among patients, from ischemia with no obstructive CAD to myocardial infarction with 3‐vessel disease. Pain tolerance has been suggested as a potential mechanism for the variation in presentation of CAD. We aimed to investigate the association between pain tolerance, coronary angiography, CAD, and death. Methods and Results We identified 9576 participants in the Tromsø Study (2007–2008) who completed the cold‐pressor pain test, and had no prior history of CAD. The median follow‐up time was 10.4 years. We applied Cox‐regression models with age as time‐scale to calculate hazard ratios (HR). More women than men aborted the cold pressor test (39% versus 23%). Participants with low pain tolerance had 19% increased risk of coronary angiography (HR, 1.19 [95% CI, 1.03–1.38]) and 22% increased risk of obstructive CAD (HR, 1.22 [95% CI, 1.01–1.47]) adjusted by age as time‐scale and sex. Among women who underwent coronary angiography, low pain tolerance was associated with 54% increased risk of obstructive CAD (HR, 1.54 [95% CI, 1.09–2.18]) compared with high pain tolerance. There was no association between pain tolerance and nonobstructive CAD or clinical presentation to coronary angiography (ie, stable angina, unstable angina, and myocardial infarction). Participants with low pain tolerance had increased risk of mortality after adjustment for CAD and cardiovascular risk factors (HR, 1.40 [95% CI, 1.19–1.64]). Conclusions Low cold pressor pain tolerance is associated with a higher risk of coronary angiography and death.Kristina FladsethHaakon LindekleivChristopher NielsenAndrea ØhrnAndreas KristensenJan MannsverkMaja‐Lisa LøchenInger NjølstadTom WilsgaardEllisiv B MathiesenAudun StubhaugThor TrovikSvein RotevatnSigne ForsdahlHenrik SchirmerWileyarticlecoronary angiographycoronary artery diseaseheart disease risk factorsmicrovascular anginapain measurementDiseases of the circulatory (Cardiovascular) systemRC666-701ENJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, Vol 10, Iss 22 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	coronary angiography coronary artery disease heart disease risk factors microvascular angina pain measurement Diseases of the circulatory (Cardiovascular) system RC666-701
spellingShingle	coronary angiography coronary artery disease heart disease risk factors microvascular angina pain measurement Diseases of the circulatory (Cardiovascular) system RC666-701 Kristina Fladseth Haakon Lindekleiv Christopher Nielsen Andrea Øhrn Andreas Kristensen Jan Mannsverk Maja‐Lisa Løchen Inger Njølstad Tom Wilsgaard Ellisiv B Mathiesen Audun Stubhaug Thor Trovik Svein Rotevatn Signe Forsdahl Henrik Schirmer Low Pain Tolerance Is Associated With Coronary Angiography, Coronary Artery Disease, and Mortality: The Tromsø Study
description	Background The initial presentation to coronary angiography and extent of coronary artery disease (CAD) vary greatly among patients, from ischemia with no obstructive CAD to myocardial infarction with 3‐vessel disease. Pain tolerance has been suggested as a potential mechanism for the variation in presentation of CAD. We aimed to investigate the association between pain tolerance, coronary angiography, CAD, and death. Methods and Results We identified 9576 participants in the Tromsø Study (2007–2008) who completed the cold‐pressor pain test, and had no prior history of CAD. The median follow‐up time was 10.4 years. We applied Cox‐regression models with age as time‐scale to calculate hazard ratios (HR). More women than men aborted the cold pressor test (39% versus 23%). Participants with low pain tolerance had 19% increased risk of coronary angiography (HR, 1.19 [95% CI, 1.03–1.38]) and 22% increased risk of obstructive CAD (HR, 1.22 [95% CI, 1.01–1.47]) adjusted by age as time‐scale and sex. Among women who underwent coronary angiography, low pain tolerance was associated with 54% increased risk of obstructive CAD (HR, 1.54 [95% CI, 1.09–2.18]) compared with high pain tolerance. There was no association between pain tolerance and nonobstructive CAD or clinical presentation to coronary angiography (ie, stable angina, unstable angina, and myocardial infarction). Participants with low pain tolerance had increased risk of mortality after adjustment for CAD and cardiovascular risk factors (HR, 1.40 [95% CI, 1.19–1.64]). Conclusions Low cold pressor pain tolerance is associated with a higher risk of coronary angiography and death.
format	article
author	Kristina Fladseth Haakon Lindekleiv Christopher Nielsen Andrea Øhrn Andreas Kristensen Jan Mannsverk Maja‐Lisa Løchen Inger Njølstad Tom Wilsgaard Ellisiv B Mathiesen Audun Stubhaug Thor Trovik Svein Rotevatn Signe Forsdahl Henrik Schirmer
author_facet	Kristina Fladseth Haakon Lindekleiv Christopher Nielsen Andrea Øhrn Andreas Kristensen Jan Mannsverk Maja‐Lisa Løchen Inger Njølstad Tom Wilsgaard Ellisiv B Mathiesen Audun Stubhaug Thor Trovik Svein Rotevatn Signe Forsdahl Henrik Schirmer
author_sort	Kristina Fladseth
title	Low Pain Tolerance Is Associated With Coronary Angiography, Coronary Artery Disease, and Mortality: The Tromsø Study
title_short	Low Pain Tolerance Is Associated With Coronary Angiography, Coronary Artery Disease, and Mortality: The Tromsø Study
title_full	Low Pain Tolerance Is Associated With Coronary Angiography, Coronary Artery Disease, and Mortality: The Tromsø Study
title_fullStr	Low Pain Tolerance Is Associated With Coronary Angiography, Coronary Artery Disease, and Mortality: The Tromsø Study
title_full_unstemmed	Low Pain Tolerance Is Associated With Coronary Angiography, Coronary Artery Disease, and Mortality: The Tromsø Study
title_sort	low pain tolerance is associated with coronary angiography, coronary artery disease, and mortality: the tromsø study
publisher	Wiley
publishDate	2021
url	https://doaj.org/article/5ec09a91c835480a9e34ff430d4aa65c
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Low Pain Tolerance Is Associated With Coronary Angiography, Coronary Artery Disease, and Mortality: The Tromsø Study

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