Cardiovascular risk factors for physician-diagnosed lumbar disc herniation.
Cardiovascular risk factors for physician-diagnosed lumbar disc herniation.
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DOI：
10.1016/j.spinee.2006.04.016
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发表时间：
2006-11-01
期刊：
影响因子：
--
通讯作者：
Stampfer, Meir J
中科院分区：
文献类型：
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作者：
Jhawar, Balraj S;Fuchs, Charles S;Stampfer, Meir J
背景：尽管腰椎间盘疾病在普通人群中患病率很高，但人们对这种疾病的决定因素仍然知之甚少。最近的一项假设表明，动脉粥样硬化性血管疾病可能在该疾病的病因学中发挥重要作用。目的：探讨心血管危险因素与腰椎间盘突出症发病率之间的关系。研究设计/背景：我们前瞻性地研究了吸烟、高胆固醇、高血压、肥胖和糖尿病与自我报告的腰椎间盘突出症之间的关联。这项研究在 98,407 名女护士中进行，她们在 1976 年年龄为 30-55 岁，没有癌症（非黑色素瘤皮肤癌除外）、腰椎间盘疾病，并回答了 1992 年关于医生是否诊断为腰椎间盘突出症的调查问卷。 结果：在 16 年的随访期间（438,662 人年），2,727 名护士没有患癌症的人报告了医生诊断的腰椎间盘突出症，并通过计算机断层扫描或磁共振成像证实。调整年龄、体重指数、吸烟、剧烈或适度运动、就业状况、去年看过医生以及以下每个其他因素后，糖尿病的多变量相对风险为 1.52（95% 置信区间 [95% CI]，1.17 至 1.98）；高血压为 1.25（95% CI，1.11 至 1.41）；对于高胆固醇，该值为 1.26（95% CI，1.10 至 1.44），对于父母在 60 岁之前患有心肌梗塞的值为 1.13（95% CI，1.02 至 1.26）。在这些模型中，与从不吸烟者相比，过去吸烟者的相对风险为1.10（95% CI，1.00至1.20），对于当前吸烟者来说，风险随着每天吸烟数量的增加而增加。戒烟后风险降低。同样在这些模型中，我们注意到随着体重指数的升高，风险增加的显着趋势 (p=.01)。结论：心血管危险因素与有症状的腰椎间盘突出症显着且独立相关。这些发现进一步证实动脉粥样硬化可能与椎间盘退变有关。改变危险因素，尤其是吸烟，也可能被证明是有益的。
BACKGROUND CONTEXT: Despite the high prevalence of lumbar disc disease among the general population, the determinants of this condition remain poorly understood. A recent hypothesis suggests that atherosclerotic vascular disease may play an important role in the etiology of this disorder.PURPOSE: To explore the relationship between cardiovascular risk factors and the incidence of lumbar disc herniation.STUDY DESIGN/SETTING: We prospectively examined the association between smoking, high cholesterol, high blood pressure, obesity, and diabetes and self-reported lumbar disc herniation. The study was conducted among 98,407 female nurses who in 1976 were ages 30-55 years, free of cancer (except non-melanoma skin cancer), lumbar disc disease, and who responded to the 1992 questionnaire regarding whether or not a physician diagnosis of lumbar disc herniation had been made.RESULTS: During 16 years of follow-up (438,662 person-years), 2,727 nurses who were free of cancer reported a physician-diagnosed lumbar disc herniation that was confirmed either by computed tomography or magnetic resonance imaging. After adjusting for age, body mass index, smoking, vigorous or moderate exercise, employment status, having seen a physician in the last year, and each of the following other factors, the multivariate relative risk for diabetes was 1.52 (95% confidence interval [95% CI], 1.17 to 1.98); for hypertension it was 1.25 (95% CI, 1.11 to 1.41); for high cholesterol it was 1.26 (95% CI, 1.10 to 1.44), and for having a parent who had suffered a myocardial infarction before age 60 it was 1.13 (95% CI, 1.02 to 1.26). In these models, compared with never smokers, the relative risk for past smokers was 1.10 (95% CI, 1.00 to 1.20), for current smokers the risk increased with the number of cigarettes smoked per day. A decrease in risk occurred after cessation. Also in these models, we noted a significant trend of increasing risk with higher body mass index (p=.01).CONCLUSIONS: Cardiovascular risk factors are significantly and independently associated with symptomatic lumbar disc herniation. These findings provide further confirmation that atherosclerosis may be involved in spinal disc degeneration. Modification of risk factors, particularly smoking, may also prove to be beneficial.