Is Chronic Low Back Pain Associated with the Prevalence of Coronary Heart Disease when Genetic Susceptibility Is Considered? A Co-Twin Control Study of Spanish Twins

Abstract

ObjectiveTo investigate the chronic low back pain and coronary heart disease relationship, after adjusting for relevant confounders, including genetics.MethodsIn a cross-sectional design, 2148 twins were recruited from the Murcia Twin Registry, Spain. The exposure was chronic LBP and the outcomes were myocardial infarction and other coronary heart diseases—lifetime and in the last 2 years–based on standardized health-related questionnaires. First, logistic regression analysis investigated associations of the total sample followed by a matched co-twin control analyses, with all complete twin pairs discordant for chronic LBP utilised, separated for zygosity—dizygotic (DZ) and monozygotic (MZ) pairs, which adjusted for shared familial factors, including genetics.ResultsChronic LBP pain is associated with lifetime myocardial infarction [odds ratio (OR) = 2.69, 95% confidence interval (CI) = 1.35–5.36], other coronary heart diseases over a lifetime (OR = 2.58, 95% CI: 1.69–3.93) and in the last two years (OR = 2.19, 95% CI: 1.33–3.60), while there was a borderline association with myocardial infarction in the last 2 years (OR = 2.64, 95% CI: 0.98–7.12). Although the magnitude of the association remained or increased in the co-twin control analyses, none reached statistical significance.ConclusionChronic LBP is associated with a higher prevalence of myocardial infarction and coronary heart disease. It is possible that this association remains even when controlling for genetics and early shared environment, although this should be investigated with larger samples of twins discordant for LBP.

Domains of Chronic Low Back Pain and Assessing Treatment Effectiveness: A Clinical Perspective

“…This association is important because changes to paraspinal muscle composition could compromise function of the muscles that control and support the low back . Whilst the exact mechanisms and causality are unknown, adults with CLBP are more likely to present with obesity‐related comorbidities, such as coronary heart disease . Individuals with a higher BMI also have greater disability before and after treatment, and it may have an important biomechanical influence on functional recovery in those with CLBP .…”

“…60,61 Whilst the exact mechanisms and causality are unknown, adults with CLBP are more likely to present with obesity-related comorbidities, such as coronary heart disease. 62 Individuals with a higher BMI also have greater disability before and after treatment, and it may have an important biomechanical influence on functional recovery in those with CLBP. 63 For example, those with CLBP and a BMI> 27 kg/m 2 have a 16% greater risk for remaining highly disabled at 1 year.…”

Comorbidities and functional disability in chronic low back pain

“…There are several mechanisms in common for chronic low back pain and myocardiopathy: high cortisol levels, sympathetic-parasympathetic disbalance, central sensibilization (pro-inflammatory cytokines), presence of anxiety, depression, and obesity, the onset of atherosclerotic changes in coronary blood vessels and lumbar arteries. 22 Diabetes mellitus didn`t statistically significantly influence the level of functional disability in our patients (p=0.682). The researches imply diabetes changes mechanical tissue characteristics, which may lead to possible disk prolapse, and inevitably to the mechanical pain in the lower back.…”

A prediction model of low back pain risk: a population based cohort study in Korea

“…Despite a high disease burden [17], the structural origin of most back pain episodes is unknown, with a poor correlation between symptoms and structural abnormalities [18,19], and often considered non-specific [20]. Risk factors associated with LBP include; female sex [21], older age [17], smoking [22], psychological stress [23], depression [24], education, occupation, income [25], high body weight [22], physical inactivity [26], coronary artery disease (CAD) [27], dyslipidemia [28], diabetes mellitus [29], disc degeneration (DD) [30], history of back injury [31], previous episodes [32], bone mineral density (BMD) disorders [33], spinal stenosis [34], and spondylolisthesis [30].…”