Cardiometabolic syndrome in people with spinal cord injury/disease: Guideline-derived and nonguideline risk components in a pooled sample

Model System:

TBI

Reference Type:

Journal

Accession No.:

J74698

Journal:

Archives of Physical Medicine and Rehabilitation

Year, Volume, Issue, Page(s):

2016 , 97, 10, 1696-1705

Publication Website:

Abstract:

Study assessed cardiometabolic syndrome (CMS) risk definitions in spinal cord injury/disease (SCI/D). Baseline data from participants 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 and women with chronic paraplegia and tetraplegia (American Spinal Injury Association Impairment Scale [AIS] grades A-D). The prevalence of CMS was computed 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. This prevalence was compared 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. After adjustment for multiple comparisons, injury level and AIS grade were unrelated to CMS or risk factors. Thirteen percent of the participants had CMS when using the sum of risks method and 32.1 percent had CMS using the HOMA2/QUICKI model. Overweight/obesity and (pre)hypertension were highly prevalent, with risk for overweight/obesity being significantly associated with CMS diagnosis. Insulin resistance was significantly associated with CMS when using the HOMA2/QUICKI model. Seventy-six percent of the subjects were at moderate-to-high risk from elevated CRP, which was significantly associated with CMS determination. 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.

Author(s):

Nash, Mark S., Tractenberg, Rochelle E., Mendez, Armando J., David, Maya, Ljungberg, Inger H., Tinsley, Emily A., Burns-Drecq, Patricia A., Betancourt, Luisa F., Groah, Suzanne L.