Revolutionizing Spine Care…Changing Lives

Is There a Link Between Heart Disease and Back Pain?

Happy New Year! What are your New Year’s resolutions? Do they include quitting smoking or obtaining better control of your diabetes and cholesterol? While most of us know that smoking, diabetes and high cholesterol puts you at an increased risk for a heart attack or stroke, did you know they can also affect your spine health?

There is growing evidence that shows a relationship between diseases of the blood vessels and low back (lumbar) issues such as degenerative disc disease (DDD). To understand why, you need to know a little bit about the anatomy of the lumbar spine, its discs and what happens when they degenerate. The intervertebral discs are made of a mixture that includes water and collagen. The discs act as a cushion and help support the vertebral bones in our spine. These discs are avascular by adulthood meaning they do not have any blood vessels that directly supply nutrition to them; instead, the outer portions of the discs are supplied by passive diffusion from lumbar and sacral arteries branching from the aorta. These arteries are harmed by smoking, diabetes and high cholesterol. In people who have cardiovascular disease such as atherosclerosis (plaque build-up in the arteries), the blood supply is significantly decreased in the smaller arteries and therefore, the discs are not obtaining as much nutrition and are more prone to degeneration.

I recently reviewed a study that looked at CT scans which showed atherosclerotic disease of the lumbar arteries and aorta correlated with lumbar DDD, facet arthritis, and spinal canal stenosis after adjusting for age.1  As mentioned above, we understand the mechanism of vascular disease and lumbar DDD, but this was the first study to show that vascular disease can also affect other degenerative issues of the spine such as facet arthritis and spinal stenosis. These findings make sense when you understand the degenerative cascade.2The discs and the facet joints are part of a three-joint complex and pathology of one component (such as the discs) influences deterioration of the other two components (facet joints) and eventually causes spinal stenosis. This overall degeneration of the spine is known as spondylosis.

There is not much you can do about vascular risk factors such as age or genetics, but you can start taking steps to address modifiable risk factors such as obesity3, smoking, diabetes, high cholesterol and high blood pressure. You can work closely with your primary care physician on your medications to better manage these conditions. Additionally, as a physiatrist at Texas Back Institute, I stress the importance of healthy habits such as routine exercise to improve cardiovascular health, physical therapy and a proper diet. Addressing these issues can not only help with overall well-being, but now research shows it can also affect the health of your spine. Cheers to a healthier year!

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1Beckworth WJ, Holbrook JF, Foster LG, et al. Atherosclerotic disease and its relationship to lumbar degenerative disk disease, facet arthritis and stenosis with computed tomography angiography. PMR. 2018;10(4):331-337.

2Choi Y-S. Pathophysiology of Degenerative Disc Disease. Asian Spine Journal. 2009;3(1):39-44.

3Shiri R, Karppinen J, Leino-Arjas P, et al. The association between obesity and low back pain: a meta-

analysis. Am J Epidemiol 2010;171:135-154.

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