The neurological level of spinal cord injury and cardiovascular risk factors: a systematic review and meta-analysis

Raguindin, Peter Francis; Fränkl, Gion; Itodo, Oche Adam; Bertolo, Alessandro; Zeh, Ramona; Capossela, Simona; Minder, Beatrice; Stoyanov, Jivko; Stucki, Gerold; Franco, Oscar H.; Muka, Taulant; Glišić, Marija

doi:10.1038/s41393-021-00678-6

Cited by 13 publications

(11 citation statements)

References 38 publications

(54 reference statements)

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“…Furthermore, in individuals with chronic SCI, the level of injury was suggested as potential non-modifiable cardiovascular risk factor, implying higher risks in individuals with tetraplegia. 10 However, a recent study reported that adding characteristics of the SCI (injury level and completeness) did not improve the performance of FRS in SCI, therefore, this merits to be explored in future studies with longer follow-up. 37 Finally, future research should also focus on validating or developing other body indices that better reflect adiposity in this group.…”

Section: Clinical Implications and Future Outlookmentioning

confidence: 98%

“…Individuals with SCI experience these more frequently and with earlier disease onset, 1‐3 which is attributed to the accumulation of cardiometabolic risk factors, namely hyperlipidemia, hypertension, glucose intolerance, and obesity, 7,8 which arise due to the impairments in the metabolic milieu, which occurs a few days or weeks following the injury and worsen thereafter. Specifically, the impairment of autonomic nervous system coupled with changes in body composition and limitations in physical activity can lead to derangements in lipid and glucose metabolism, and blood pressure dysregulation 9‐13 . Despite the available evidence regarding the higher CVD risk in chronic SCI, 2,7,14 the early changes in CMD risk factors following the injury have been insufficiently explored 15‐18 …”

Section: Introductionmentioning

confidence: 99%

“…Furthermore, changes in CMD risk factors can depend on injury characteristics, which have not been accounted for in most studies conducted in the subacute phase of the injury. Individuals with tetraplegia and motor complete injuries may have poorer lipid profile and fat composition compared to individuals with paraplegia and motor incomplete injuries, respectively 9,10 . Understanding the early changes in CMD risk factors in individuals with SCI and whether these changes differ by injury characteristics can provide insight that might reduce the risks of CMD.…”

Section: Introductionmentioning

confidence: 99%

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Cardiometabolic risk profiling during spinal cord injury rehabilitation: A longitudinal analysis from the Swiss Spinal Cord Injury (SwiSCI) cohort

Raguindin

Stoyanov

Eriks‐Hoogland

et al. 2022

PM&R

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BACKGROUND Early screening is important in individuals with spinal cord injury (SCI) as they were deemed high-risk for cardiometabolic diseases. Few studies explored changes in cardiometabolic risk profile in the early phase of the injury. Thus, it remains unclear how early the cardiometabolic status deteriorates after injury. OBJECTIVE We determined the longitudinal changes in the cardiometabolic risk profile and examined the association between injury characteristics and cardiometabolic status in subacute SCI. SETTING Multicenter Swiss Spinal Cord Injury Cohort. PARTICIPANTS Adults with traumatic SCI without history of cardiovascular disease or type 2 diabetes. MAIN OUTCOME MEA-SURES Blood pressure (BP), lipid profile, fasting glucose, waist circumference (WC), weight, body mass index (BMI) and Framingham risk score (FRS) were compared across time and according to the injury characteristics. RESULTS We analyzed the data of 258 individuals with traumatic SCI (110 tetraplegia and 148 paraplegia, 122 motor complete and 136 incomplete). The median age was 50 years (IQR 32-60), with 76.36% (n=197) of the population being male. The median rehabilitation duration was 5.5 months (IQR 3.2-7.1). At admission to rehabilitation, fully-adjusted linear regression models showed higher baseline weight ( 0.06, 95% CI 0.005, 0.11), systolic BP ( 0.05, 95% CI 0.008, 0.09), diastolic BP ( 0.05 95% CI 0.004, 0.10), and triglycerides ( 0.27 95% CI 0.13, 0.42) in paraplegia than tetraplegia. Systolic BP, diastolic BP, HDL-C were higher in incomplete than complete injury. In our main analysis, we observed an increase in cholesterol and HDL-C and lipid ratio when comparing the beginning and end of rehabilitation. Individuals with paraplegia had a higher increase in BMI than tetraplegia, while no differences in other cardiometabolic risk factors were detected when comparing motor incomplete and complete injury. Trajectories of each participant showed that the majority of individuals with SCI decreased FRS score at follow-up compared to baseline and no significant changes in prevalence of cardiometabolic syndrome were observed. At discharge, one-third of study participants were classified as moderate to high risk of CVD, 64% were overweight, and 39.45% had cardiometabolic syndrome. CONCLUSION We observed a modest improvement in lipid profile and FRS during the first inpatient rehabilitation hospitalization. Injury characteristics, such as level and completeness, were not associated with changes in cardiometabolic risk factors in the subacute phase of the injury. Despite this, a significant proportion of study participants remained at risk of cardiometabolic disease at discharge, suggesting that early cardiometabolic preventive strategies may be initiated as early as during the first inpatient rehabilitation hospitalization.

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Section: Clinical Implications and Future Outlookmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Cardiometabolic risk profiling during spinal cord injury rehabilitation: A longitudinal analysis from the Swiss Spinal Cord Injury (SwiSCI) cohort

Raguindin

Stoyanov

Eriks‐Hoogland

et al. 2022

PM&R

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“…These cardiovascular disorders are important because they cause high morbidity and mortality in SCI patients. The prevalence of death from cardiovascular complications reaches up to 30 percent of deaths in SCI patients (3,34).…”

Section: Introductionmentioning

confidence: 99%

Comparison of Heart Rate Variability of Chronic Spinal Cord Injury Patients in Supine and Sitting Positions

Sangkoy¹,

Putra²,

Sulastri³

2022

IJRP

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Background: Sympathetic and parasympathetic activity shift in response to body position changing. Spinal cord injury (SCI) patients have problems controlling autonomic functions occurs as a result of an imbalance between the sympathetic and parasympathetic nervous systems. Despite the fact that changing body position is often used in SCI rehabilitation, few studies have compared the autonomic activity of SCI patients at different body positions. Heart rate variability (HRV) can be used to invasively assess cardiac autonomic modulation. This study aims to obtain information about the autonomic modulation features of SCI patients in supine and sitting positions using HRV measurements. Methods:This study was a cross-sectional study approach. Participants of this study were 14 chronic SCI patients with injury durations more than a year. Measurement of HRV is using Polar H10 (1B56EB2E). HRV measurements in the subjects of this study were Root Mean Square of the Successive Differences (RMSSD) and Low Frequency/High Frequency (LF/HF) ratio in supine and sitting positions.Results: There was a significant difference in the value of RMSSD in chronic SCI patients from supine to sitting position (p 0.019). There was no significant difference in the value of LF/HF ratio in chronic SCI patients from supine to sitting position (p 0.408).Conclusions: Parasympathetic activity (RMSSD) decreased significantly in chronic SCI patients due to postural changing from supine to sitting position. Despite the fact that sympathetic activity is disrupted in SCI patients, the sympathovagal balance can still be maintained with changes in body position.

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“…Individuals aging with a spinal cord injury (SCI) demonstrate an increased prevalence and accelerated risk of cardiovascular and cerebrovascular events such as ischemic strokes and myocardial infarctions (MI) (1,2). Contrary to initial clinical assumption, the increased incidence of vascular disease in adults with chronic SCI does not appear to be solely due to worsening of traditional risk factors, such as increased adiposity, blood pressure instability, dyslipidemia, and insulin resistance, but also involves illde ned SCI speci c factors (3). In fact, after controlling for traditional risk factors, individuals with SCI demonstrate asymptomatic atherosclerotic vascular disease in carotid and coronary arteries (4)(5)(6).…”

Section: Introductionmentioning

confidence: 99%

Development of a hypercoagulable-hypofibrinolytic state early after spinal cord injury

Park

Garcia²,

Greiner³

et al. 2022

Preprint

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Study Design: Cross sectional study. Objectives: To determine whether spinal cord injury (SCI) is associated with adverse changes in coagulation and fibrinolytic factors that underlie thrombogenesis and contribute to atherothrombotic events such as myocardial infarctions (MI) and strokes. Setting: Adults with subacute SCI and non-injured community dwelling adults. Methods: Thirty young and middle-aged (20-58 years) adults were studied: 14 non-injured (11M/4F) and 16 with subacute SCI (13M/3F; time since injury: 11.8±5.3 wk). Circulating markers of coagulation [von Willebrand factor (vWf) and factors VII, VIII, and X], the fibrinolytic system [tissue-type plasminogen activator (t-PA), and plasminogen activator inhibitor-1 (PAI-1) antigen and activity], and fibrin formation (D-dimer) were determined by enzyme immunoassay. Results: Circulating levels of coagulation factors VII, VIII and X were significantly higher (~20-45%) in the adults with SCI than non-injured adults; whereas, vWf was similar between groups. Fibrinolytic markers were adversely disrupted with SCI with t-PA antigen, PAI-1 antigen and PAI-1 activity were markedly higher (~50-800%; P<0.05) in adults with SCI compared with non-injured adults. The molar concentration ratio of active t-PA to PAI-1 was significantly higher (~350%) in adults with SCI. Concordant with coagulation cascade activation and fibrinolytic system inhibition, D-dimer concentrations were markedly ~70% higher (P<0.05) in adults with SCI compared with non-injured adults. Conclusions: Subacute tetraplegic motor complete SCI is associated with a prothrombotic hemostatic profile. Adverse changes in the coagulation cascade and fibrinolytic system appear to occur early after injury and may contribute to the increased atherothrombotic risk in adults living with SCI.

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The neurological level of spinal cord injury and cardiovascular risk factors: a systematic review and meta-analysis

Cited by 13 publications

References 38 publications

Cardiometabolic risk profiling during spinal cord injury rehabilitation: A longitudinal analysis from the Swiss Spinal Cord Injury (SwiSCI) cohort

Cardiometabolic risk profiling during spinal cord injury rehabilitation: A longitudinal analysis from the Swiss Spinal Cord Injury (SwiSCI) cohort

Comparison of Heart Rate Variability of Chronic Spinal Cord Injury Patients in Supine and Sitting Positions

Development of a hypercoagulable-hypofibrinolytic state early after spinal cord injury

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