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已发表论文
纵向疼痛模式与中国绝经女性心血管疾病风险：抑郁和体重指数的中介作用
Authors Ding F, Han Y, Huang J, Sun Y , Zhang K, Xu Y, Xu H
Received 29 June 2025
Accepted for publication 6 November 2025
Published 2 December 2025 Volume 2025:17 Pages 5063—5077
DOI https://doi.org/10.2147/IJWH.S550346
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 3
Editor who approved publication: Dr Matteo Frigerio
Fangfang Ding,1 Yan Han,2 Jiajun Huang,1 Yiye Sun,1 Ke Zhang,1 Yujie Xu,1 Hua Xu3
1Department of Anesthesiology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China; 2Department of Neurology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China; 3Department of Algology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, People’s Republic of China
Correspondence: Hua Xu, Department of Algology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, People’s Republic of China, Email pshhuaxu@163.com
Purpose: Cardiovascular disease (CVD) and chronic pain substantially affect menopausal women. However, evidence is scarce regarding how the course of pain over time—specifically, whether it is persistent and affects multiple body sites—influences the future risk of CVD in this population. This study aimed to investigate the longitudinal association between these novel pain phenotypes and incident CVD, and to evaluate the mediating roles of depressive symptoms and body mass index (BMI).
Patients and Methods: This prospective analysis included 4,890 postmenopausal women from the China Health and Retirement Longitudinal Study (CHARLS). Pain status (location, intensity) and CVD were assessed at baseline (2013) and follow-up (2018). Persistent pain was defined as pain reported at both time points. We used regression models to examine the association between pain patterns and incident CVD, and mediation analysis to quantify the contribution of depressive symptoms and BMI.
Results: At baseline (cross-sectional), pain presence, intensity, and multisite distribution were associated with higher CVD prevalence. Over five years (longitudinal), persistent pain phenotypes predicted incident CVD after adjustment: general persistent pain (OR = 1.05, 95% CI: 1.00– 1.08, p = 0.012), persistent low back pain (OR = 1.08, 95% CI: 1.03– 1.13, p = 0.001), and persistent multisite pain (OR = 1.06, 95% CI: 1.00– 1.11, p = 0.020). Depressive symptoms mediated 21.6% of the association for persistent pain; for persistent low back pain, depressive symptoms (14.5%) and BMI (5.4%) were significant mediators.
Conclusion: Among postmenopausal women, long-standing and multisite pain is associated with higher future CVD risk. A modest portion of these associations was statistically accounted for by depressive symptoms and, for low back pain, BMI. Assessing pain persistence and distribution may help identify women who could benefit from integrated appraisal of pain, mood, and metabolic health.
Keywords: menopausal women, chronic pain, CVD, depressive symptoms, China Health and Retirement Longitudinal Study, CHARLS, BMI
1Department of Anesthesiology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China; 2Department of Neurology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China; 3Department of Algology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, People’s Republic of China
Correspondence: Hua Xu, Department of Algology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, People’s Republic of China, Email pshhuaxu@163.com
Purpose: Cardiovascular disease (CVD) and chronic pain substantially affect menopausal women. However, evidence is scarce regarding how the course of pain over time—specifically, whether it is persistent and affects multiple body sites—influences the future risk of CVD in this population. This study aimed to investigate the longitudinal association between these novel pain phenotypes and incident CVD, and to evaluate the mediating roles of depressive symptoms and body mass index (BMI).
Patients and Methods: This prospective analysis included 4,890 postmenopausal women from the China Health and Retirement Longitudinal Study (CHARLS). Pain status (location, intensity) and CVD were assessed at baseline (2013) and follow-up (2018). Persistent pain was defined as pain reported at both time points. We used regression models to examine the association between pain patterns and incident CVD, and mediation analysis to quantify the contribution of depressive symptoms and BMI.
Results: At baseline (cross-sectional), pain presence, intensity, and multisite distribution were associated with higher CVD prevalence. Over five years (longitudinal), persistent pain phenotypes predicted incident CVD after adjustment: general persistent pain (OR = 1.05, 95% CI: 1.00– 1.08, p = 0.012), persistent low back pain (OR = 1.08, 95% CI: 1.03– 1.13, p = 0.001), and persistent multisite pain (OR = 1.06, 95% CI: 1.00– 1.11, p = 0.020). Depressive symptoms mediated 21.6% of the association for persistent pain; for persistent low back pain, depressive symptoms (14.5%) and BMI (5.4%) were significant mediators.
Conclusion: Among postmenopausal women, long-standing and multisite pain is associated with higher future CVD risk. A modest portion of these associations was statistically accounted for by depressive symptoms and, for low back pain, BMI. Assessing pain persistence and distribution may help identify women who could benefit from integrated appraisal of pain, mood, and metabolic health.
Keywords: menopausal women, chronic pain, CVD, depressive symptoms, China Health and Retirement Longitudinal Study, CHARLS, BMI