Continuous chronic back pain >1 year and incident cardiovascular disease in elderly men: results from the ULSAM-study

BACKGROUND: Chronic back pain is a major cause of disability and a socioeconomic burden. Previous studies on back pain have suggested a moderately increased risk for cardiovascular mortality in elderly women, but evidence in elderly men is lacking. We investigated the association between continuous chronic back pain for more than a year and incident cardiovascular events in a cohort of elderly men. METHODS: The Uppsala Longitudinal Study of Adult Men (ULSAM), a community-based cohort of elderly men (mean age, 71 years; n=1,024), was used to investigate the association between continuous back pain lasting more than one year and incident cardiovascular events (defined as a composite of coronary heart disease, cerebrovascular disease or cardiovascular mortality). RESULTS: During up to 20 years follow-up, 504 individuals developed a cardiovascular event. In Cox proportional-hazards models adjusted for a large number of established cardiovascular risk factors, socioeconomic factors, and lifestyle factors (age, systolic blood pressure, antihypertensive treatment, high- and low-density lipoprotein-cholesterol, triglycerides, lipid-lowering treatment, glomerular filtration rate, urinary albumin excretion, body mass index, diabetes, diabetes medication, insulin-sensitivity, C-reactive protein, educational level, smoking, physical activity) continuous chronic back pain was robustly associated with a more than 70 % increased risk for cardiovascular events (multivariable hazard ratio 1.71, 95 % confidence intervals 1.23-2.37, p<0.001). CONCLUSIONS: Continuous chronic back pain for more than a year is a risk factor for cardiovascular events in elderly men. Our findings confirm previous evidence, highlighting chronic pain as a clinically relevant and under-recognized risk factor for cardiovascular disease that warrants consideration in future clinical guidelines.