Abstract
Objectives
To (1) describe the prevalence of cardiometabolic disease (CMD) at spinal cord injury
(SCI) rehabilitation discharge; (2) compare this with controls without SCI; and (3)
identify factors associated with increased CMD.
Design
Multicenter, prospective observational study.
Setting
Five National Institute on Disability, Independent Living, and Rehabilitation Research
Model SCI Rehabilitation Centers.
Participants
SCI (n=95): patients aged 18-70 years, with SCI (neurologic levels of injury C2-L2,
American Spinal Injury Association Impairment Scale grades A-D), and enrolled within
2 months of initial rehabilitation discharge. Control group (n=1609): age/sex/body
mass index–matched entries in the National Health and Nutrition Examination Education
Survey (2016-2019) (N=1704).
Interventions
None
Main Outcome Measures
Percentage of participants with SCI with CMD diagnosis, prevalence of CMD determinants
within 2 months of rehabilitation discharge, and other significant early risk associations
were analyzed using age, sex, body mass index, insulin resistance (IR) by fasting
glucose and Homeostasis Model Assessment (v.2), fasting triglycerides, high-density
lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol, total cholesterol,
and resting blood pressure (systolic and diastolic).
Results
Participants with SCI had significantly higher diastolic blood pressure and triglycerides
than those without SCI, with lower fasting glucose and HDL-C. A total of 74.0% of
participants with SCI vs 38.5% of those without SCI were obese when applying population-specific
criteria (P<.05). Low HDL-C was measured in 54.2% of participants with SCI vs 15.4% of those
without (P<.05). IR was not significantly different between groups. A total of 31.6% of participants
with SCI had ≥3 CMD determinants, which was 40.7% higher than those without SCI (P<.05). Interplay of lipids and lipoproteins (ie, total cholesterol:HDL-C ratio and
triglyceride:HDL-C ratio) were associated with elevated risk in participants with
SCI for myocardial infarction and stroke. The only significant variable associated
with CMD was age (P<.05).
Conclusions
Individuals with SCI have an increased CMD risk compared with the general population;
obesity, IR, and low HDL-C are the most common CMD risk determinants; age is significantly
associated with early CMD.
Keywords
List of abbreviations:
AIS (American Spinal Injury Association Impairment Scale), BMI (body mass index), CI (confidence interval), CMD (cardiometabolic disease), CVD (cardiovascular disease), HDL-C (high-density lipoprotein cholesterol), LDL-C (low-density lipoprotein cholesterol), NHANES (National Health and Nutrition Examination Survey), NLI (neurologic level of injury), OR (odds ratio), PVA (Paralyzed Veterans of America), SCI (spinal cord injury)To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Archives of Physical Medicine and RehabilitationAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Cardiovascular disease and spinal cord injury: results from a national population health survey.Neurology. 2013; 81: 723-728
- Cardiovascular disease in spinal cord injury: an overview of prevalence, risk, evaluation, and management.Am J Phys Med Rehabil. 2007; 86: 142-152
- Mortality in the United States.NCHS Data Brief. 2017; 2018: 1-8
- Cardiometabolic risk clustering and atherosclerosis: is there a link in spinal cord injury?.Top Spinal Cord Inj Rehabil. 2011; 16: 1-13
- Cardiometabolic syndrome in people with spinal cord injury/disease: guideline-derived and non-guideline risk components in a pooled sample.Arch Phys Med Rehabil. 2016; 97: 1696-1705
- Cardiometabolic syndrome: a global health issue.US Pharm. 2017; 42 (HS19-21)
- Metabolic syndrome–a new world-wide definition. A consensus statement from the International Diabetes Federation.Diabet Med. 2006; 23: 469-480
- Coronary heart disease in individuals with spinal cord injury: assessment of risk factors.Spinal Cord. 2008; 46: 466-476
- A guideline-driven assessment of need for cardiovascular disease risk intervention in persons with chronic paraplegia.Arch Phys Med Rehabil. 2007; 88: 751-757
- Identification and management of cardiometabolic risk after spinal cord injury.J Spinal Cord Med. 2019; 42: 643-677
- Sarcopenic obesity in adults with chronic spinal cord injury: a cross-sectional study.Arch Phys Med Rehabil. 2016; 97: 1931-1937
- Guideline approaches for cardioendocrine disease surveillance and treatment following spinal cord injury.Curr Phys Med Rehabil Rep. 2018; 6: 264-276
- Updates for the international standards for neurological classification of spinal cord injury.Phys Med Rehabil Clin N Am. 2014; 25: 505-517
- Lowering body mass index cutoffs better identifies obese persons with spinal cord injury.Spinal Cord. 2009; 47: 757-762
- Correct homeostasis model assessment (HOMA) evaluation uses the computer program.Diabetes Care. 1998; 21: 2191-2192
- Measurement of blood pressure in humans: a scientific statement from the American Heart Association.Hypertension. 2019; 73: e35-e66
- Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge.Clin Chem. 1972; 18: 499-502
- 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society.Circulation. 2014; 129: S139-S140
- Total cholesterol/HDL cholesterol ratio vs LDL cholesterol/HDL cholesterol ratio as indices of ischemic heart disease risk in men: the Quebec Cardiovascular Study.Arch Int Med. 2001; 161: 2685-2692
- Triglyceride-to-HDL-cholesterol ratio and metabolic syndrome as contributors to cardiovascular risk in overweight patients.Obesity. 2010; 18: 1608-1613
- Effects of spinal cord injury on body composition and metabolic profile–part I.J Spinal Cord Med. 2014; 37: 693-702
- Central adiposity associations to carbohydrate and lipid metabolism in individuals with complete motor spinal cord injury.Metab Clin Exp. 2011; 60: 843-851
- Regional and relative adiposity patterns in relation to carbohydrate and lipid metabolism in men with spinal cord injury.Appl Physiol Nutr Metab. 2011; 36: 107-114
- Nutritional status in chronic spinal cord injury: a systematic review and meta-analysis.Spinal Cord. 2019; 57: 3-17
- High density lipoprotein cholesterol concentrations in physically active and sedentary spinal cord injured patients.Arch Phys Med Rehabil. 1986; 67: 445-450
- HDL cholesterol across a spectrum of physical activity from quadriplegia to marathon running.Lancet. 1983; 1: 1212-1213
- Glucose-intolerance due to insulin resistance in patients with spinal-cord injuries.Diabetes. 1980; 29: 906-910
- Endocrinology and metabolism of persons with spinal cord injury.In Kirshblum S, Lin VW editors. Spinal cord medicine. 3rd ed. New York City: Springer Publishing Company, 2018: 278-317
- Implication of altered autonomic control for orthostatic tolerance in SCI.Auton Neurosci. 2018; 209: 51-58
- Renin-angiotensin-aldosterone system and oxidative stress in cardiovascular insulin resistance.Am J Physiol Heart Circ Physiol. 2007; 293: H2009-H2023
- Inflammatory stress effects on health and function after spinal cord injury.Top Spinal Cord Inj Rehabil. 2017; 23: 207-217
- Neurogenic obesity and systemic inflammation following spinal cord injury: a review.J Spinal Cord Med. 2018; 41: 378-387
- Comparison of the gut microbiome composition among individuals with acute or long-standing spinal cord injury vs. able-bodied controls.J Spinal Cord Med. 2020; : 1-9
- Reducing cardiometabolic disease in spinal cord injury.Phys Med Rehabil Clin N Am. 2014; 25: 573-604
- A lifestyle intervention program for successfully addressing major cardiometabolic risks in persons with SCI: a three-subject case series.Spinal Cord Ser Cases. 2017; 3: 17007
- Effect of short-term low-intensity exercise on insulin sensitivity, insulin secretion, and glucose and lipid metabolism in non-obese Japanese type 2 diabetic patients.Horm Metab Res. 2002; 34: 27-31
- Modification of insulin sensitivity and glycemic control by activity and exercise.Med Sci Sprts Exerc. 2013; 45: 1868-1877
- Effects of circuit resistance training and timely protein supplementation on exercise-induced fat oxidation in tetraplegic adults.Top Spinal Cord Inj Rehabil. 2014; 20: 113-122
- Evidence for an exaggerated postprandial lipemia in chronic paraplegia.J Spinal Cord Med. 2005; 28: 320-325
- The influence of visceral fat on the postprandial lipemic response in men with paraplegia.J Am Coll Nutr. 2010; 29: 476-481
- Effects of prandial challenge on triglyceridemia, glycemia, and pro-inflammatory activity in persons with chronic paraplegia.J Spinal Cord Med. 2015; 38: 468-475
- National Health and Nutrition Examination Survey. HCHS Fact Sheet.July 2020 (Available at:)https://www.cdc.gov/nchs/about/factsheets/factsheet_nhanes.htmDate accessed: June 9, 2021
Article info
Publication history
Published online: May 28, 2021
Accepted:
April 26,
2021
Received in revised form:
March 29,
2021
Received:
December 31,
2020
Footnotes
Presented as an abstract at the American Spinal Injury Association Annual Conference, April 2-5, 2019, Honolulu, HI.
Supported by the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR) (grant no. 90SI5023).
Disclosures: none
Identification
Copyright
© 2021 Published by Elsevier Inc. on behalf of The American Congress of Rehabilitation Medicine.
