Association of inflammatory indices with coronary artery calcium burden in fibromyalgia

Fibromyalgia (FM) may involve systemic abnormalities in addition to its characteristic nociplastic pain features. This study aimed to investigate the association between routinely available inflammatory indices, particularly the neutrophil-to-lymphocyte ratio (NLR), and coronary artery calcium (CAC) burden in patients with FM. A total of 142 patients with FM and 64 controls were included. Computed tomography-derived CAC scores were categorized as < 100 or ≥ 100, with CAC ≥ 400 examined as an exploratory threshold. Multiple inflammatory indices were evaluated, and multivariable logistic regression models included demographic and cardiovascular risk factors, with additional adjustment for low-density lipoprotein cholesterol and statin use. NLR differed across the 3 groups after Bonferroni correction for multiple testing; pairwise analysis showed a higher NLR in patients with FM and CAC ≥ 100 than in those with CAC < 100. Among the evaluated inflammatory indices, NLR showed the strongest correlation with CAC score ( r = 0.371, Bonferroni-adjusted P < .001). After additional adjustment for diabetes mellitus, hypertension, low-density lipoprotein cholesterol, and statin use, NLR remained associated with CAC ≥ 100 (adjusted odds ratio 3.57, 95% confidence interval 1.15–11.07, P = .028) and CAC ≥ 400 (adjusted odds ratio 3.97, 95% confidence interval 1.14–13.81, P = .030). Receiver operating characteristic analyses showed limited-to-modest discriminatory performance of NLR for CAC ≥ 100 (area under the curve 0.67) and CAC ≥ 400 (area under the curve 0.69). This study identified an independent association between NLR and CAC burden in patients with FM, despite modest between-group differences and limited-to-modest discriminatory performance. These findings are hypothesis-generating and support prospective evaluation of NLR as part of multimarker cardiovascular assessment in FM.