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, and findings are hypothesis-generating and support prospective evaluation of NLR as part of multimarker cardiovascular assessment in FM.
NLR showed the strongest correlation with CAC score among all evaluated inflammatory indices in fibromyalgia patients.
NLR was independently associated with high coronary artery calcium burden (CAC ≥ 100) in fibromyalgia patients after multivariable adjustment.
NLR remained independently associated with the exploratory high CAC threshold (CAC ≥ 400) after full multivariable adjustment.
NLR demonstrated limited-to-modest discriminatory performance for identifying high coronary artery calcium burden in fibromyalgia patients.
NLR differed significantly across the three study groups (FM with CAC ≥ 100, FM with CAC < 100, and controls) after correction for multiple testing.
Fibromyalgia may involve systemic abnormalities beyond its characteristic nociplastic pain features, including cardiovascular-related inflammatory changes.
This research suggests that in people with fibromyalgia (FM), a common chronic pain condition, a simple blood test ratio called the neutrophil-to-lymphocyte ratio (NLR) — which reflects inflammation — is linked to the amount of calcium deposits found in the coronary arteries. Calcium deposits in the heart arteries are a sign of early or subclinical cardiovascular disease. The study compared 142 FM patients (divided by how much calcium was in their arteries) to 64 healthy controls, and found that FM patients with higher calcium scores also tended to have higher NLR values, even after accounting for traditional heart disease risk factors like diabetes, high blood pressure, cholesterol levels, and statin use. The association was statistically significant, with FM patients having higher NLR being roughly 3.5 to 4 times more likely to have high coronary calcium scores. However, the researchers were careful to note that NLR alone was not a precise enough tool to reliably identify who has high calcium burden — its accuracy was described as 'limited-to-modest,' with test performance scores (AUC) of only 0.67 to 0.69 out of a perfect 1.0. This means NLR on its own cannot replace dedicated cardiovascular testing. This research suggests that systemic inflammation, as reflected by NLR, may play a role in cardiovascular risk in fibromyalgia patients, and that this routinely available blood marker could potentially be useful as part of a broader cardiovascular assessment in this population. The authors emphasize that these findings are preliminary and hypothesis-generating, and call for larger prospective studies to confirm whether monitoring NLR alongside other markers could help identify FM patients at elevated cardiovascular risk.
Çağlar S, Hira S, Çağlar H. (2026). Association of inflammatory indices with coronary artery calcium burden in fibromyalgia: A retrospective CT-based cross-sectional study.. Medicine. https://doi.org/10.1097/MD.0000000000050656