Subclinical atherosclerosis is related to injury level but not to inflammatory parameters in spinal cord injury subjects

Abstract

Study design: Cross-sectional. Objectives: Individuals with spinal cord injury (SCI) exhibit increased carotid intima-media thickness (IMT) and are reported to be exposed to higher circulating levels of inflammatory mediators. This study evaluated the relationship between inflammatory markers and carotid surrogates of cardiovascular risk in subjects with SCI. Setting: São Paulo, Brazil. Methods: A total of 65 nondiabetic, nonhypertensive, sedentary, nonsmoker men (34 with SCI; 31 healthy subjects) were evaluated by medical history, anthropometry, routine laboratory tests, analysis of hemodynamic, inflammatory parameters and ultrasound examination of carotid arteries. Results: Subjects with SCI (18 tetraplegic and 16 paraplegic) had lower systolic blood pressure (P ¼ 0.009), higher serum C-reactive protein (P ¼ 0.001), tumor necrosis factor (TNF) receptor-II (P ¼ 0.02) and TNF receptor-I (P ¼ 0.04) levels and increased in vitro production of interleukin-6 by mononuclear cells (P ¼ 0.04), compared to able-bodied individuals. No differences in serum interleukin-6, e-selectin, intercellular adhesion molecule-1, vascular cell adhesion molecule-1 and transforming growth factor-b levels, or in vitro release of interleukin-10, interleukin-17 and interferon-g by mononuclear cells, were detected between the studied groups. Common carotid IMT, but not internal carotid resistive index, was significantly higher in subjects with SCI (Po0.0001 adjusted for C-reactive protein and TNF receptor-II levels). In addition, tetraplegic subjects exhibited increased IMT (P ¼ 0.002 adjusted for systolic blood pressure and body mass index), but similar levels of inflammatory mediators compared to paraplegic ones. Conclusions: Individuals with SCI exhibit a clustering of vascular and inflammatory surrogates of increased cardiovascular risk. Nevertheless, subclinical carotid atherosclerosis is related to injury level but not to increased inflammatory status in these subjects.

Altered left ventricular diastolic function in subjects with spinal cord injury

“…3 Interestingly, this process is not explained by traditional cardiovascular risk factors, indicating that alternative mechanisms might influence the development of early atherosclerosis in such individuals. 3 On the other hand, patients with SCI are exposed to higher circulating levels of inflammatory markers in comparison with able-bodied individuals, 4 suggesting inflammatory mechanisms to be potential candidates to explain the increased cardiovascular risk in these subjects.…”

Evidence for greater burden of peripheral arterial disease in lower extremity arteries of spinal cord-injured individuals

“…This is similar to results demonstrating no difference in CA-IMT between physically active SCI and age-matched controls. (14) Our absolute CA-IMT measurements for all SCI were slightly larger than those previously reported in 28 wheelchair athletes, ϳ0.10 mm, but were 0.15 mm smaller than those reported for 34 SCI, including injuries causing paraplegia and tetraplegia (18). Interestingly, the normalized IMT in the BA was smaller in our SCI group.…”

“…Interestingly, the mortality risk from CVD is 5-10% greater in SCI compared with age-and risk factor-matched able-bodied individuals (22). Specifically, it has been demonstrated that spinal cord injury leads to greater coronary artery calcification (24) and T-wave abnormalities (33), but evidence is equivocal regarding the development of subclinical atherosclerotic markers of carotid artery (CA) intima-media thickening and arterial stiffness (14,18). The potential mechanisms for atherosclerosis in SCI include disorders of carbohydrate metabolism (1), dyslipidemia (1,28), lower-extremity physical inactivity, and the resultant loss of lean body tissue (21), reduced daily energy expenditure (5), and greater prevalence of type 2 diabetes (2).…”

Treino de natação para pessoas sedentárias com lesão medular e concentração de colesterol-HDL

“…Além do baixo nível de atividade física, coexistem, nesta população, uma miríade de condições deletérias para a saúde como obesidade central com elevada quantidade de gordura visceral, altos índices da proteína C reativa (associada ao estado inflamatório), aumento da espessura íntima da carótida, e o perfil lipídico desfavorável é mais uma condição que predispõe estas pessoas a eventos cardiovasculares [5][6][7][8] .…”