"Angina pectoris, abdominal or intestinal angina, and claudicatio intermittens are all well-known clinical pain syndromes related to ischemia as a result of regional atherosclerotic arteries. A decade ago Kauppila (1) hypothesized that low-back pain could be due to atherosclerosis of the small lumbar arterial vessels. The hypothesis was later supported by studies using magnetic resonance (MR) (2), which has shown occlusion in these arteries more often in patients with low-back pain than in controls, and, in postmortem studies, occluded or narrowed arteries were more often found in patients with low-back pain (3). Most of the studies have been cross-sectional or have at least collected information on low-back pain in retrospect, with the risk of information bias.In this issue of the Scandinavian Journal of Work Environment & Health, Leino-Arjas and her co-workers report a cohort study (4) in which risk factors for cardiovascular disease (CVD) were related to the development of low-back pain 28 years later among industrial employees. The paper finds that, especially for the men, smoking, high body mass index (BMI), high cholesterol, high triglycerides, and high blood pressure, alone and in combination, predict low-back pain and thus support the atherosclerotic origin of low-back pain. ..."

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