Fibromyalgia Tied to Far Higher Odds of Severe Coronary Artery Disease in Angiography Patients

Fibromyalgia, a chronic pain syndrome long viewed as a rheumatologic condition, may carry a striking signal for the heart. A cross-sectional study of 347 patients who underwent coronary angiography, published open access in Advances in Rheumatology on 28 August 2026, reports that fibromyalgia was independently associated with roughly a 26-fold higher odds of severe coronary artery disease, defined by a SYNTAX score above 22.

Group A comprised 130 patients with normal angiography. Group B included 152 patients with obstructive disease but a SYNTAX score of 22 or below, indicating less complex coronary anatomy. Group C contained 65 patients with a SYNTAX score greater than 22, marking severe and anatomically complex coronary artery disease.

Fibromyalgia is characterized by chronic widespread pain, tenderness, sleep disturbance, and impaired function, and it shares several risk factors with coronary artery disease, including obesity, diabetes, rheumatic diseases, and depression.

Across the cohort, 59 patients, or 17.0 percent, met the criteria for fibromyalgia. The distribution was not even across the angiographic groups. Patients in Group C, those with the most severe disease, had a higher prevalence of older individuals, males, diabetes, dyslipidemia, and fibromyalgia, along with lower levels of vitamin D and physical activity, compared with the other groups.

Because these factors cluster together, the investigators turned to multivariable logistic regression to disentangle the independent contribution of fibromyalgia. After adjusting for age, sex, diabetes, physical activity, LDL cholesterol level, and vitamin D level, fibromyalgia remained associated with approximately 26.4-fold higher odds of severe coronary artery disease, with an odds ratio of 26.38, a 95 percent confidence interval of 7.41 to 93.90, and a p value below 0.001.

The magnitude of that association is unusual in cardiovascular epidemiology, and the authors conclude that fibromyalgia was independently associated with substantially higher odds of severe disease after adjustment for prespecified demographic and clinical covariates. The wide confidence interval, however, reflects the limited number of severe cases in the cohort, so the precise strength of the association remains uncertain even though the statistical signal is strong.

Several caveats temper interpretation. As a cross-sectional study, the design captures patients at a single point in time and cannot establish that fibromyalgia causes coronary disease or worsens it; the association could reflect shared mechanisms, reverse pathways, or residual confounding by factors not measured, such as depression severity, medication use, or chronic inflammation. The study also examined only patients already referred for angiography, so the findings may not generalize to people with fibromyalgia in the wider population who have never been tested for coronary disease.

Using an anatomical severity measure rather than clinical outcomes such as heart attacks means the study links fibromyalgia to disease extent visible on angiography, not directly to prognosis.

Mechanistically, the authors note that fibromyalgia and coronary artery disease could have an independent association beyond their shared risk factors, a hypothesis the data are consistent with but cannot prove.

Subject of Research: The association between fibromyalgia and coronary artery disease severity measured by the SYNTAX score in patients undergoing coronary angiography.

Article Title: Association between fibromyalgia and severity of coronary artery disease assessed by SYNTAX score: a cross-sectional study of 347 patients

Article References: Atabati, E., Ghazaee, H., Hosseini, S. H., Khajavi, O., Mehrad-Majd, H., & Azdaki, N. (2026). Association between fibromyalgia and severity of coronary artery disease assessed by SYNTAX score: a cross-sectional study of 347 patients. Advances in Rheumatology. https://doi.org/10.1186/s42358-026-00576-6

Image Credits: AI Generated

DOI: 10.1186/s42358-026-00576-6

Keywords: fibromyalgia, coronary artery disease, SYNTAX score, coronary angiography, cross-sectional study, 2016 ACR criteria, cardiovascular risk, odds ratio, chronic pain, rheumatology, Association, between