Allen, Victoria E.2017-02-062017-02-062016http://udspace.udel.edu/handle/19716/20443Musculoskeletal conditions have been recognized as a significant health problem, due to their impact on individuals and health systems, and are the second greatest cause of disability worldwide. Musculoskeletal complaints are most common in older adults, with 70% of older adults reporting joint pain and nearly 50% of older adults experiencing chronic pain. Chronic pain in older adults is associated with many lifestyle and biological factors that are also well-established, significant risk factors for cardiovascular disease (CVD). With CVD being the leading cause of mortality in the world, there is a need to identify populations that may be at greater risk for adverse cardiovascular (CV) health profiles. PURPOSE: To determine if older adults with chronic back pain have adverse CV risk profiles by utilizing comprehensive, objective clinical and physiological measures of CV function and subclinical disease. HYPOTHESIS: Among older adults, chronic back pain will be associated with greater CV risk profiles. METHODS: Secondary data analyses were conducted to evaluate the relationship between back pain severity and CV risk profiles in a large cohort of community-dwelling older adults (n=3075). Secondary data analyses were also used to determine if older adults with high-severity back pain were at greater risk for CV events, CV-related and total mortality. Additionally, through primary data collection, CV health status was comprehensively evaluated utilizing physiological markers of CVD risk and vascular function among older adults with (n=21) and without (n=21) chronic low back and radicular leg pain. RESULTS: In the large cohort of community-dwelling older adults, those with chronic back pain were found to exhibit greater CV risk profiles, and were more likely to experience an adverse coronary heart disease event, such as a heart attack, angina or congestive heart failure, when compared to older adults without back pain. Despite being more likely to experience an adverse CV event, older adult with back pain were not more likely to experience CV-related or total mortality; thus, chronic back pain appeared to be associated with greater morbidity, but not mortality in the older adult cohort. In the primary data collection, compared to pain-free older adults, those with chronic low back and radicular leg pain, were found to have greater CV risk profiles, and appeared to have attenuated endothelial function, suggesting the presence of subclinical atherosclerotic disease. The association between pain status and reduced endothelial function may be related to risk factors including elevated systemic inflammation, reduced exercise capacity and lower levels of physical activity. CONCLUSIONS: Due to the prevalence of modifiable lifestyle and biological CV risk factors exhibited by older adults with chronic back pain, it appears they may be at an increased risk for CVD development, as well as adverse CV events. Additionally, older adults with chronic low back and radicular leg pain may exhibit greater endothelial dysfunction, compared to pain-free older adults; a relationship that may be influenced by elevated levels of systemic inflammation and reduced physical activity.Musculoskeletal diseases in old age.Backache.Chronic pain.Cardiovascular system -- Aging.Cardiovascular diseases in old age -- Risk factors.Thesis971482922https://doi.org/10.58088/pqa3-dn14