Mark S Nash1, Rochelle E Tractenberg2, Armando J Mendez3, Maya David4, Inger H Ljungberg5, Emily A Tinsley5, Patricia A Burns-Drecq4, Luisa F Betancourt4, Suzanne L Groah5. 1. Department of Neurological Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, FL; Department of Physical Medicine and Rehabilitation, and Medicine, Leonard M. Miller School of Medicine, University of Miami, Miami, FL; The Miami Project to Cure Paralysis, Leonard M. Miller School of Medicine, University of Miami, Miami, FL. Electronic address: mnash@med.miami.edu. 2. Collaborative for Research on Outcomes and Metrics, Georgetown University Medical Center, Washington, DC; Department of Neurology, Georgetown University Medical Center, Washington, DC; Department of Biostatistics, Bioinformatics and Biomathematics, Georgetown University Medical Center, Washington, DC; Department of Rehabilitation Medicine, Georgetown University Medical Center, Washington, DC. 3. Department of Medicine, Leonard M. Miller School of Medicine, University of Miami, Miami, FL; Diabetes Research Institute, Leonard M. Miller School of Medicine, University of Miami, Miami, FL. 4. The Miami Project to Cure Paralysis, Leonard M. Miller School of Medicine, University of Miami, Miami, FL. 5. MedStar National Rehabilitation Hospital, Washington, DC.
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, χ(2)=10.105; adjusted P=.008). Insulin resistance was significantly associated with CMS when using the HOMA2/QUICKI model (χ(2)2=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, χ(2)2=10.198; adjusted P=.048 and HOMA2/QUICKI, χ(2)2=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.
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, χ(2)=10.105; adjusted P=.008). Insulin resistance was significantly associated with CMS when using the HOMA2/QUICKI model (χ(2)2=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, χ(2)2=10.198; adjusted P=.048 and HOMA2/QUICKI, χ(2)2=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.
Authors: Mark S Nash; Suzanne L Groah; David R Gater; Trevor A Dyson-Hudson; Jesse A Lieberman; Jonathan Myers; Sunil Sabharwal; Allen J Taylor Journal: J Spinal Cord Med Date: 2019-06-10 Impact factor: 1.985
Authors: Mark S Nash; Suzanne L Groah; David R Gater; Trevor A Dyson-Hudson; Jesse A Lieberman; Jonathan Myers; Sunil Sabharwal; Allen J Taylor Journal: Top Spinal Cord Inj Rehabil Date: 2018