Cardiometabolic Syndrome in People with Spinal Cord Injury/Disease: Guideline-derived and Non-Guideline Risk Components in a Pooled Sample

Publication date: Available online 25 July 2016
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Mark S. Nash, Rochelle E. Tractenberg, Armando J. Mendez, Maya David, Inger H. Ljungberg, Emily A. Tinsley, Patricia A. Burns, Luisa F. Betancourt, Suzanne L. Groah
ObjectiveAssess cardiometabolic syndrome (CMS) risk definitions in spinal cord injury/disease (SCI/D).DesignCross-sectional analysis of a pooled sample.SettingTwo SCI/D academic medical and rehabilitation centers.ParticipantsBaseline data from subjects in seven clinical studies were pooled; not all variables were collected in all studies so that participant numbers varied from 119-389. The pooled sample included males (79%) and females (21%) with SCI/D >1 year at spinal cord levels spanning C3-T2 (AIS A-D).InterventionsNot applicable.Main Outcome MeasuresWe computed the prevalence of CMS using the American Heart Association (AHA)/National Heart Lung Blood Institute (NHLBI) guideline (CMS diagnosis as sum-of-risks (SUM-OF-RISKS) ≥ 3) for the following risk components: overweight/obesity, insulin resistance, hypertension, and dyslipidemia. We compared this prevalence with the risk calculated from two routinely used non-guideline 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 upon an inflammation (C-Reactive Protein [CRP]) - adjusted Total Cholesterol (TC): High-density Lipoprotein Cholesterol (HDL-C) ratio.ResultsAfter adjustment for multiple comparisons, injury level and AIS were unrelated to CMS or risk factors. 13% and 32.1% of participants 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=0.008). Insulin resistance was significantly associated with CMS when using the HOMA2/QUICKI model (χ² (2) =21.23, adjusted p<0.001). 76.4% of subjects were at moderate/high risk from elevated CRP, which was significantly associated with CMS determination (both methods; sum-of-risks [χ² (2) =10.198, adjusted p=0.048] and HOMA2/QUICKI [χ² (2) =10.532, adjusted p=0.04]).ConclusionsAs 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.



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