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Determinants of lumbar artery occlusion among patients with sciatica: A three-year follow-up with magnetic resonance angiography

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Abstract

We showed previously that chronic Chlamydia pneumoniae infection increases the risk of lumbar artery occlusion. We did not evaluate, however, the effect of other risk factors for cardiovascular diseases in combination with this chronic infection. The purpose of this study was to investigate the combined effect of chronic C. pneumoniae infection and other known determinants of artery occlusion in a population of sciatica patients. Two-dimensional time-of-flight magnetic resonance angiography (MRA) was used to evaluate lumbar arteries at baseline and three years. The arteries on both sides (L1–L4) were evaluated visually and scored as normal, narrowed or occluded. Logistic regression analysis was performed separately for baseline total arterial stenosis and each L1–L4 segmental artery pair, and for incident new stenosis during the follow-up period. The determinants analyzed included age, body mass index (BMI, kg/m2), education, gender, and smoking, in addition to presence of chronic C. pneumoniae infection. MRA was obtained at baseline for 147 patients and at 3 years for 134 patients. Sixty-four (47.8%) of 134 patients had new arterial stenosis. Total incidence of new arterial stenosis was distributed quite evenly between the individual segmental levels, varying from 12.7 to 18.6%. BMI was the only predictor of new arterial stenosis (odds ratio (OR) 1.13). A reasonable logistic model could be established only for baseline L4 and total arterial scores. At L4, education was a protective factor (OR 0.07), whereas age (OR for the oldest age group 6.7) and BMI (OR 1.17) were associated with increased risk of occlusion. For total arterial score, chronic C. pneumoniae infection was an independent determinant of arterial occlusion, increasing the risk to almost eightfold. Additionally, BMI (OR 1.16), and age (for the oldest age group OR 11.4) were significant determinants for stenosis. Smoking was not statistically significant. As chronic C. pneumoniae infection was an independent determinant of lumbar artery occlusion, treatments of this chronic infection may have an impact on lumbar diseases. The importance of BMI for new arterial stenosis suggests that weight reduction may also have a beneficial effect in lumbar artery disease.

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References

  1. Angeja BG, Kermgard S, Chen MS, McKay M, Murphy SA, Antman EM, Cannon CP, Braunwald E, Gibson CM (2002) The smoker’s paradox: insights from the angiographic substudies of the TIMI trials. J Thromb Thrombolysis 13:133–139

    Article  Google Scholar 

  2. Bachmaier K, Neu N, de la Maza LM, Pal S, Hessel A, Penninger JM (1999) Chlamydia infections and heart disease linked through antigenic mimicry. Science 283:1335–1339

    Article  Google Scholar 

  3. Battie MC, Bigos SJ, Fisher LD, Hansson TH, Nachemson AL, Spengler DM, Wortley MD, Zeh J (1989) A prospective study of the role of cardiovascular risk factors and fitness in industrial back pain complaints. Spine 14:141–147

    Google Scholar 

  4. Benetos A, Waeber B, Izzo J, Mitchell G, Resnick L, Asmar R, Safar M (2002) Influence of age, risk factors, and cardiovascular and renal disease on arterial stiffness: clinical applications. Am J Hypertens 15:1101–1108

    Article  Google Scholar 

  5. Burns DM (2003) Epidemiology of smoking-induced cardiovascular disease. Prog Cardiovasc Dis 46:11–29

    Article  Google Scholar 

  6. Georges JL, Rupprecht HJ, Blankenberg S, Poirier O, Bickel C, Hafner G, Nicaud V, Meyer J, Cambien F, Tiret L, AtheroGene Group (2003) Impact of pathogen burden in patients with coronary artery disease in relation to systemic inflammation and variation in genes encoding cytokines. Am J Cardiol 92:515–521

    Article  Google Scholar 

  7. Gutierrez J, Linares-Palomino J, Lopez-Espada C, Rodriguez M, Ros E, Piedrola G, del Maroto MC (2001) Chlamydia pneumoniae DNA in the arterial wall of patients with peripheral vascular disease. Infection 29:196–200

    Article  Google Scholar 

  8. Heliövaara M, Mäkelä M, Aromaa A, Impivaara O, Knekt P, Reunanen A (1995) Low back pain and subsequent cardiovascular mortality. Spine 20:2109–2111

    Google Scholar 

  9. Jee SH, Suh I, Kim IS, Appel LJ (1999) Smoking and atherosclerotic cardiovascular disease in men with low levels of serum cholesterol: the Korea Medical Insurance Corporation Study. J Am Med Assoc 282:2149–2155

    Article  Google Scholar 

  10. Juvonen J, Juvonen T, Laurila A, Alakärppä H, Lounatmaa K, Surcel HM, Leinonen M, Kairaluoma MI, Saikku P (1997) Demonstration of Chlamydia pneumoniae in the walls of abdominal aortic aneurysms. J Vasc Surg 25:499–505

    Google Scholar 

  11. Kannel WB, Wilson PW, Nam BH, D’Agostino RB (2002) Risk stratification of obesity as a coronary risk factor. Am J Cardiol 90:697–701

    Article  Google Scholar 

  12. Karppinen J, Mikkonen P, Kurunlahti M, Tervonen O, Paldanius M, Vasari P, Saikku P, Vanharanta H (2003) Chronic Chlamydia pneumoniae infection increases the risk of occlusion of lumbar segmental arteries of patients with sciatica: a 3-year follow-up study. Spine 28:E284–E289

    Article  Google Scholar 

  13. Kauppila LI (1995) Can low-back pain be due to lumbar-artery disease? Lancet 346:888–889

    Article  Google Scholar 

  14. Kauppila LI (1997) Prevalence of stenotic changes in arteries supplying the lumbar spine. A postmortem angiographic study on 140 subjects. Ann Rheum Dis 56:591–595

    CAS  PubMed  Google Scholar 

  15. Kauppila LI, McAlindon T, Evans S, Wilson PW, Kiel D, Felson DT (1997) Disc degeneration/back pain and calcification of the abdominal aorta. A 25-year follow-up study in Framingham. Spine 22:1642–1647

    Article  Google Scholar 

  16. Kauppila LI, Penttilä A, Karhunen PJ, Lalu K, Hannikainen P (1994) Lumbar disc degeneration and atherosclerosis of the abdominal aorta. Spine 19:923–929

    Google Scholar 

  17. Kauppila LI, Tallroth K (1993) Postmortem angiographic findings for arteries supplying the lumbar spine: their relationship to low-back symptoms. J Spinal Disord 6:124–129

    Google Scholar 

  18. Kilander L, Berglund L, Boberg M, Vessby B, Lithell H (2001) Education, lifestyle factors and mortality from cardiovascular disease and cancer. A 25-year follow-up of Swedish 50-year-old men. Int J Epidemiol 30:1119–1126

    Article  Google Scholar 

  19. Kurunlahti M, Tervonen O, Vanharanta H, Ilkko E, Suramo I (1999) Association of atherosclerosis with low back pain and the degree of disc degeneration. Spine 24:2080–2084

    Article  Google Scholar 

  20. Kurunlahti M, Karppinen J, Haapea M, Niinimäki J, Autio R, Vanharanta H, Suramo I, Tervonen O (2004) Three-year follow-up of lumbar artery occlusion with magnetic resonance angiography in sciatica patients. Associations between occlusion and patient-reported symptoms. Spine 29:1804–1808

    Article  Google Scholar 

  21. Laurila A, Bloigu A, Näyhä S, Hassi J, Leinonen M, Saikku P (1997) Chronic Chlamydia pneumoniae infection is associated with a serum lipid profile known to be a risk factor for atherosclerosis. Arterioscler Thromb Vasc Biol 17:2910–2913

    Google Scholar 

  22. Leboeuf-Yde C (1999) Smoking and low back pain. A systematic literature review of 41 journal articles reporting 47 epidemiologic studies. Spine 24:1463–1470

    Article  Google Scholar 

  23. Lehto S, Niskanen L, Suhonen M, Rönnemaa T, Saikku P, Laakso M (2002) Association between Chlamydia pneumoniae antibodies and intimal calcification in femoral arteries of nondiabetic patients. Arch Intern Med 162:594–599

    Article  Google Scholar 

  24. Leino M, Raitakari OT, Porkka KV, Taimela S, Viikari JS (1999) Associations of education with cardiovascular risk factors in young adults: the Cardiovascular Risk in Young Finns Study. Int J Epidemiol 28:667–675

    Article  Google Scholar 

  25. Leino-Arjas P, Kaila-Kangas L, Keskimäki I, Notkola V, Mutanen P (2002) Inpatient hospital care for lumbar intervertebral disc disorders in Finland in relation to education, occupational class, income, and employment. Public Health 116:272–278

    Article  Google Scholar 

  26. Leinonen M, Saikku P (2002) Evidence for infectious agents in cardiovascular disease and atherosclerosis. Lancet Infect Dis 2:11–17

    Google Scholar 

  27. Penttinen J (1995) Risk of myocardial infarction among subjects visiting a doctor because of back disorder. A case–control study in Finnish farmers. Spine 20:2774–2776

    Google Scholar 

  28. Power C, Frank J, Hertzman C, Schierhout G, Li L (2001) Predictors of low back pain onset in a prospective British study. Am J Public Health 91:1671–1678

    Google Scholar 

  29. Raitakari OT, Leino M, Rakkonen K, Porkka KV, Taimela S, Räsänen L, Viikari JS (1995) Clustering of risk habits in young adults. The Cardiovascular Risk in Young Finns Study. Am J Epidemiol 142:36–44

    Google Scholar 

  30. Saikku P, Leinonen M, Mattila K, Ekman MR, Nieminen MS, Mäkelä PH, Huttunen JK, Valtonen V (1988) Serological evidence of an association of a novel Chlamydia, TWAR, with chronic coronary heart disease and acute myocardial infarction. Lancet 2:983–986

    Article  CAS  PubMed  Google Scholar 

  31. Strong JP, McGill HCJ (1962) The natural history of coronary atherosclerosis. Am J Pathol 40:37–49

    Google Scholar 

  32. van Rossum CT, van de Mheen H, Witteman JC, Mackenbach JP, Grobbee DE (1999) Socioeconomic status and aortic atherosclerosis in Dutch elderly people: the Rotterdam Study. Am J Epidemiol 150:142–148

    Google Scholar 

  33. Wang XL, Raveendran M, Wang J (2003) Genetic influence on cigarette-induced cardiovascular disease. Prog Cardiovasc Dis 45:361–382

    Google Scholar 

  34. Ward ME (1995) The immunobiology and immunopathology of chlamydial infections. APMIS 103:769–796

    Google Scholar 

  35. Wilson PW, Kauppila LI, O’Donnell CJ, Kiel DP, Hannan M, Polak JM, Cupples LA (2001) Abdominal aortic calcific deposits are an important predictor of vascular morbidity and mortality. Circulation 103:1529–1534

    Google Scholar 

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Authors and Affiliations

  1. Department of Occupational Medicine, Finnish Institute of Occupational Health, Helsinki, Department of Physical Medicine and Rehabilitation, Oulu University Hospital, Oulu, and ORTON Orthopaedic Hospital, Helsinki

    Jaro Karppinen

  2. Department of Diagnostic Radiology, Oulu University Hospital, Oulu

    Mauno Kurunlahti, Marianne Haapea & Osmo Tervonen

  3. DBC Ltd., Helsinki, Finland

    Simo Taimela

  4. Leeds Musculoskeletal Service, Chapel Allerton Hospital, Leeds, U.K

    Heikki Vanharanta

Authors
  1. Jaro Karppinen
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  2. Mauno Kurunlahti
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  3. Simo Taimela
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  4. Marianne Haapea
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  5. Heikki Vanharanta
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  6. Osmo Tervonen
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Correspondence to Jaro Karppinen.

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Karppinen, J., Kurunlahti, M., Taimela, S. et al. Determinants of lumbar artery occlusion among patients with sciatica: A three-year follow-up with magnetic resonance angiography. Eur Spine J 14, 664–670 (2005). https://doi.org/10.1007/s00586-004-0860-8

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  • DOI: https://doi.org/10.1007/s00586-004-0860-8

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