June 27, 2023 – When Carole E., a retired accounting assistant from Albuquerque, NM, was in her 60s, she began experiencing neck pain. She found that three of her cervical vertebrae were compressed and her entire spinal canal was narrowed.
“The neck problem was treated with surgery to stabilize the discs and prevent further compression that could have led to paralysis,” said Carole, now 81.
Although surgery fixed Carole's neck, she continued to have problems together with her back. She developed degenerative disc disease and for the past three years she has suffered severe hip pain, muscle spasms and cramps in her legs, and arthritis in a rotator cuff.
Carole also developed a heart condition.
“I've always had a heart murmur, but it was very quiet and faint and I was told not to worry,” she said. “But about 3 years ago it became a 'moderate' murmur and the cardiologist said we should keep an eye on it and check it every 6 months.”
The heart murmur suddenly became “severe” and surprised her cardiologist. Carole had a successful heart valve substitute surgery a couple of months ago.
Now there may be latest evidence to support what happened to Carole and others like her. It suggests that individuals like Carole, who're at high risk of heart disease, are significantly more prone to develop muscle and joint diseases (so-called musculoskeletal disorders).
Common but little researched
The study's lead creator, Kurt Hegmann, MD, MPH, professor of family and preventive medicine on the University of Utah and director of the Rocky Mountain Center for Occupational and Environmental Health, explained the motivation for the study.
“Such injuries are common and affect most people several times in their lives,” he said. Up to 5% of the US population has carpal tunnel syndrome, a full 41% suffer from tennis elbow (also called lateral epicondylitis), and up to a third have tears in the rotator cuff.
These conditions are “painful, disabling, may require surgery and cause chronic pain,” Hegmann said. “In short, they will disable people.the each day life and pleasures of individuals.”
But although they're quite common, there may be “little scientific evidence” investigating their cause, he said.We designed this study to comprehensively discover the danger aspects that cause these common problems and thus contribute to their prevention.”
The researchers examined 9 years of information from 1,224 staff across various employment sectors (manufacturing, healthcare, office jobs, and food processing) in three states: Illinois, Utah, and Wisconsin.
At the beginning of the study, participants filled out questionnaires about their age, gender, medical conditions (similar to diabetes), tobacco use, hobbies, exercise habits, depression and job satisfaction. They were also asked about symptoms similar to tingling and numbness and underwent physical examinations and nerve conduction studies. Their body mass index (BMI) was calculated based on their height and weight, and their blood pressure was measured.
Participants were followed monthly to trace the event of symptoms of musculoskeletal disorders. Conditions studied included carpal tunnel syndrome, tennis elbow, golfer's elbow, and rotator cuff tendinitis.
The researchers then compared the event of those diseases with the danger of heart problems. They used a way derived from the Framingham Heart Study – a commonly used method to check an individual’s 10-year risk of developing heart disease.
All analyses also took into consideration aspects that might influence the outcomes, similar to BMI or the physical strain on participants at work.
“Early warning signal?”
The results were astonishing.”The risks were as much as 17 times higher, which is as strong because the link between lung cancer and smoking. This link was so large that it surprised us quite a bit,” said Hegmann.
Participants with a 15 percent increased risk of heart disease were four times more likely to develop one or more musculoskeletal disorders than those with a low risk of heart disease. Their risk of developing four or more musculoskeletal disorders was 17 times higher.
“There is significant evidence that the small blood vessels to injured tissue are damaged by cardiovascular risks. So the information overwhelmingly suggest that these injuries are as a result of cardiovascular risks,” said Hegmann.
On the other hand, people with musculoskeletal disorders “may also reduce their activity levels, which could lead to an increased risk of other cardiovascular problems, such as heart attacks.”
Carole says that in recent years she has become largely immobile due to physical pain in her hips and legs.
“After my heart valve substitute, I began cardiac rehabilitation, but cycling hurts my hips and legs and I'm in tremendous pain. And the machines I exploit to coach my arms also hurt my shoulders,” she said.
She has decided to see a pain management specialist who can show her how to exercise safely and without pain.
Hegmann said that reducing the risk of cardiovascular disease “reduces the danger of ever having one in all these common musculoskeletal injuries.”
Conversely, “the more such injuries a person suffers, the more important it is to keep that person’s cardiovascular risk under control.”
In fact, the authors say, musculoskeletal disorders could possibly be considered potential “early warning signals” of heart problems, as they will occur in people without visible heart problems years and even a long time before the onset of cardiac symptoms.