Article

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, chi(2)=10.105; adjusted P=.008). Insulin
resistance was significantly associated with CMS when using the HOMA2/QUICKI
model (chi(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, chi(2)2=10.198; adjusted P=.048 and
HOMA2/QUICKI, chi(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.
CI - Copyright (c) 2016 American Congress of Rehabilitation Medicine. Published by
Elsevier Inc. All rights reserved.

Langue : ANGLAIS