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Cardiometabolic Syndrome in People With Spinal Cord Injury/Disease: Guideline-Derived and Nonguideline Risk Components in a Pooled Sample

      Abstract

      Objective

      To assess cardiometabolic syndrome (CMS) risk definitions in spinal cord injury/disease (SCI/D).

      Design

      Cross-sectional analysis of a pooled sample.

      Setting

      Two SCI/D academic medical and rehabilitation centers.

      Participants

      Baseline data from subjects in 7 clinical studies were pooled; not all variables were collected in all studies; therefore, participant numbers varied from 119 to 389. The pooled sample included men (79%) and women (21%) with SCI/D >1 year at spinal cord levels spanning C3-T2 (American Spinal Injury Association Impairment Scale [AIS] grades A–D).

      Interventions

      Not applicable.

      Main Outcome Measures

      We computed the prevalence of CMS using the American Heart Association/National Heart, Lung, and Blood Institute guideline (CMS diagnosis as sum of risks ≥3 method) for the following risk components: overweight/obesity, insulin resistance, hypertension, and dyslipidemia. We compared this prevalence with the risk calculated from 2 routinely used nonguideline CMS risk assessments: (1) key cut scores identifying insulin resistance derived from the homeostatic model 2 (HOMA2) method or quantitative insulin sensitivity check index (QUICKI), and (2) a cardioendocrine risk ratio based on an inflammation (C-reactive protein [CRP])–adjusted total cholesterol/high-density lipoprotein cholesterol ratio.

      Results

      After adjustment for multiple comparisons, injury level and AIS grade were unrelated to CMS or risk factors. Of the participants, 13% and 32.1% had CMS when using the sum of risks or HOMA2/QUICKI model, respectively. Overweight/obesity and (pre)hypertension were highly prevalent (83% and 62.1%, respectively), with risk for overweight/obesity being significantly associated with CMS diagnosis (sum of risks, χ2=10.105; adjusted P=.008). Insulin resistance was significantly associated with CMS when using the HOMA2/QUICKI model (χ22=21.23, adjusted P<.001). Of the subjects, 76.4% were at moderate to high risk from elevated CRP, which was significantly associated with CMS determination (both methods; sum of risks, χ22=10.198; adjusted P=.048 and HOMA2/QUICKI, χ22=10.532; adjusted P=.04).

      Conclusions

      As expected, guideline-derived CMS risk factors were prevalent in individuals with SCI/D. Overweight/obesity, hypertension, and elevated CRP were common in SCI/D and, because they may compound risks associated with CMS, should be considered population-specific risk determinants. Heightened surveillance for risk, and adoption of healthy living recommendations specifically directed toward weight reduction, hypertension management, and inflammation control, should be incorporated as a priority for disease prevention and management.

      Keywords

      List of abbreviations:

      AHA (American Heart Association), AIS (American Spinal Injury Association Impairment Scale), CMS (cardiometabolic syndrome), CRP (C-reactive protein), HDL-C (high-density lipoprotein cholesterol), HOMA2 (homeostatic model 2), QUICKI (quantitative insulin sensitivity check index), SCI/D (spinal cord injury/disease), TC (total cholesterol)
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