Maes, Michael, Twisk, Frank Nm · Neuro endocrinology letters · 2009
This review examines why people with ME/CFS may develop heart problems earlier than others. The researchers found that ME/CFS involves abnormal inflammation and oxidative stress (damage from harmful molecules in the body), along with low levels of protective antioxidants. These biological changes can damage the heart and blood vessels, potentially explaining why some ME/CFS patients experience heart failure at much younger ages than the general population.
This study addresses a serious gap in ME/CFS research: the observation that patients die from heart failure 25 years earlier than the general population. Understanding the biological mechanisms behind this increased cardiovascular risk could inform preventive screening, therapeutic interventions, and help validate ME/CFS as a serious medical condition with measurable physiological consequences.
This mechanistic review does not prove that any single IO&NS pathway directly causes cardiovascular disease in ME/CFS patients, nor does it establish causation rather than association. The study does not present new experimental data and cannot rule out other contributing factors to premature cardiovascular mortality, such as reduced physical activity, medication effects, or healthcare disparities.
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →
The first block is for the primary paper and is the citation you should use in research work. The atlas-snapshot line only applies if you are specifically referring to this atlas’s reading of the paper on the date shown.
Primary citation
Maes, Michael & Twisk, Frank Nm (2009). Why myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) may kill you: disorders in the inflammatory and oxidative and nitrosative stress (IO&NS) pathways may explain cardiovascular disorders in ME/CFS.. Neuro endocrinology letters. https://pubmed.ncbi.nlm.nih.gov/20038921/
BibTeX
@article{mecfsatlas-maes-2009-why-myalgic,
author = {Maes, Michael and Twisk, Frank Nm},
title = {Why myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) may kill you: disorders in the inflammatory and oxidative and nitrosative stress (IO&NS) pathways may explain cardiovascular disorders in ME/CFS.},
journal = {Neuro endocrinology letters},
year = {2009},
note = {PubMed: 20038921},
url = {https://www.mecfsatlas.com/evidence/maes-2009-why-myalgic},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-30. https://www.mecfsatlas.com/evidence/maes-2009-why-myalgic
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