Cardiovascular

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

TL;DR

Continuous chronic back pain for more than a year is a risk factor for cardiovascular events in elderly men, with a more than 70% increased risk after adjustment for established cardiovascular, socioeconomic, and lifestyle risk factors.

Key Findings

Continuous chronic back pain lasting more than one year was robustly associated with increased risk for incident cardiovascular events in elderly men.

  • Multivariable hazard ratio of 1.71 (95% CI: 1.23–2.37, p<0.001) for cardiovascular events in those with chronic back pain
  • The composite cardiovascular outcome included coronary heart disease, cerebrovascular disease, or cardiovascular mortality
  • 504 out of 1,024 participants developed a cardiovascular event during up to 20 years of follow-up
  • The association remained robust after adjustment for a large number of established cardiovascular, socioeconomic, and lifestyle risk factors

The study cohort consisted of community-based elderly men with a mean age of 71 years followed for up to 20 years.

  • Data came from the Uppsala Longitudinal Study of Adult Men (ULSAM), a community-based cohort
  • Sample size was n=1,024 elderly men with mean age of 71 years
  • Follow-up period was up to 20 years
  • 504 individuals developed a cardiovascular event during follow-up

Cox proportional-hazards models were adjusted for a comprehensive set of cardiovascular and lifestyle covariates.

  • Covariates included age, systolic blood pressure, antihypertensive treatment, HDL- and LDL-cholesterol, triglycerides, and lipid-lowering treatment
  • Additional covariates included glomerular filtration rate, urinary albumin excretion, BMI, diabetes, diabetes medication, and insulin sensitivity
  • Further adjustment was made for C-reactive protein, educational level, smoking, and physical activity
  • Chronic back pain was defined as continuous back pain lasting more than one year

The findings confirm and extend previous evidence suggesting an association between chronic pain and cardiovascular disease, which had previously been observed primarily in elderly women.

  • Prior studies on back pain had suggested a moderately increased risk for cardiovascular mortality in elderly women
  • Evidence in elderly men had previously been lacking
  • Authors conclude that chronic pain is 'a clinically relevant and under-recognized risk factor for cardiovascular disease'
  • The authors suggest this warrants consideration in future clinical guidelines

What This Means

This research suggests that older men who experience continuous back pain lasting more than one year face a substantially higher risk of developing serious cardiovascular problems—including heart disease, stroke, or cardiovascular death—compared to those without such chronic pain. Using data from a long-term Swedish study of over 1,000 men with an average age of 71, researchers found that this risk was more than 70% higher even after accounting for a wide range of known heart disease risk factors such as blood pressure, cholesterol, diabetes, kidney function, obesity, smoking, and physical activity levels. The study followed participants for up to 20 years, during which roughly half developed a cardiovascular event. This research matters because chronic back pain is one of the most common and disabling conditions worldwide, yet it has not traditionally been considered a cardiovascular risk factor in clinical practice. While some earlier research had hinted at a link between chronic pain and cardiovascular mortality in elderly women, this study provides evidence that the same relationship exists in elderly men. The biological mechanisms are not fully established, but chronic pain is known to cause persistent stress responses, inflammation, disrupted sleep, and reduced physical activity, all of which could contribute to cardiovascular damage over time. The authors suggest that healthcare providers may want to consider chronic back pain as a marker of elevated cardiovascular risk, particularly in older male patients. This research implies that managing chronic pain in elderly individuals may have benefits that extend beyond pain relief itself, and that clinical guidelines for cardiovascular risk assessment might benefit from incorporating chronic pain status as a relevant factor.

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Citation

Peterson M, W&#xe4;ndell P, R&#xf6;nneg&#xe5;rd A, Schillemans T, &#xc4;rnl&#xf6;v J. (2026). Continuous chronic back pain &gt;1&#xa0;year and incident cardiovascular disease in elderly men: results from the ULSAM-study.. Scandinavian journal of pain. https://doi.org/10.1515/sjpain-2026-0020