Ongoing pain one year after a heart attack could be just as harmful as smoking or having diabetes, according to a large new study from Sweden.
Researchers found that patients with persistent pain faced a much higher risk of dying early—regardless of where in the body the pain was located.
The study, led by researchers from Dalarna University, Region Dalarna, Karolinska Institutet, and Uppsala University, followed 98,400 people who had suffered a heart attack.
Data came from the national SWEDEHEART quality register, and patients were tracked for up to 16 years.
The results were striking: those with severe pain one year after their heart attack had up to a 70% higher risk of dying during the follow-up period compared with patients who reported no pain.
This increased risk was similar to well-known heart health threats such as smoking and high blood pressure.
Importantly, the risk applied even to people who had no other health problems. “We demonstrate that even younger, normal-weight patients without other symptoms who reported having pain had an increased risk of death,” said Professor Johan Ärnlöv from Dalarna University and Karolinska Institutet.
“This also applied to those who did not have chest pain, which suggests that persistent pain—regardless of where on the body—is a risk often overlooked in cardiac care.”
The researchers emphasize that the pain did not have to be in the chest to be dangerous. Whether in the back, joints, or elsewhere, long-term pain seemed to be linked with worse survival rates after a heart attack. This challenges the idea that only chest pain is significant in heart disease follow-up.
Persistent pain after a heart attack is not rare. In this study, 43% of participants reported mild to severe pain a year later. Despite this, chronic pain is often underestimated in heart health discussions.
Since 2019, the World Health Organization (WHO) has recognized chronic pain as a disease in its own right. The researchers believe it should also be treated as an independent risk factor for early death, especially in people who have already had a heart attack.
“We need to more strongly recognize chronic pain as a risk factor for premature death, not simply a symptom,” said study co-author Lars Berglund, adjunct professor at Dalarna University and affiliated with Uppsala University.
This research builds on an earlier study from 2023, which looked at 18,000 patients over eight years. By using a dataset five times larger and tracking people for up to twice as long, the new findings provide stronger evidence of the connection between persistent pain and early death in heart attack survivors.
The full study is published in the journal IJC Heart & Vasculature.
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