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Pain after a heart attack is as deadly as smoking, a study has concluded
Last reviewed: 09.08.2025
Pain that persists one year after a heart attack may be associated with a significant risk of death, comparable to the effects of smoking and diabetes, according to a new study of nearly 100,000 patients by researchers from Dalarna University, Dalarna Regional Council, Karolinska Institutet and Uppsala University.
The researchers followed 98,400 patients enrolled in the national quality registry SWEDEHEART after a heart attack for up to 16 years and found that patients who reported pain one year after their heart attack had a significantly higher risk of premature death. This also applies to patients without chest pain, indicating that pain, regardless of its location in the body, can increase risk.
"We found that patients with severe pain had a 70% higher risk of dying during follow-up than those without pain. This puts pain on par with smoking and high blood pressure as risk factors," says Lars Berglund, associate professor at Dalarna University, affiliated with Uppsala University.
Pain Raises Risk—Even Without Other Risk Factors
The findings also hold true for patients without other risk factors, such as being overweight or having diabetes.
"We showed that even young, normal-weight patients with no other symptoms who reported chest pain had an increased risk of death. This also applied to those who did not have chest pain, which suggests that persistent pain – regardless of its location – is an often overlooked risk in cardiology practice," says Johan Ernljov, professor at Dalarna University and Karolinska Institutet.
Long-term pain is a common problem; however, its impact on cardiovascular disease remains underestimated. Since 2019, the World Health Organization (WHO) has recognized chronic pain as an independent disease. According to researchers, it is time for the medical community to also recognize it as an independent risk factor.
"We need to take chronic pain more seriously as a risk factor for premature death, rather than just a symptom. This study will increase our understanding of how pain affects long-term prognosis after a heart attack," says Lars Berglund.
This study is based on data from the SWEDEHEART quality registry and includes 98,400 patients. During the observation period (up to 16 years), almost 15,000 deaths were recorded. One year after the heart attack, 43% of patients reported mild or severe pain.
This project is a follow-up to a previously published study in 2023 that included 18,000 patients and followed them for about eight years. The current study therefore draws on a dataset five times larger, providing stronger evidence of the link between long-term pain and premature death after a heart attack.
The study was conducted in collaboration between Dalarna University, Dalarna Regional Council and Uppsala University. The results are published in the journal IJC Heart & Vasculature.