Relationship of cardiometabolic disease risk factors with age and spinal cord injury duration

Abstract

Context/Objectives

Cardiometabolic disease (CMD) is increased after spinal cord injury (SCI), with an increased number of CMD risk factors that relate to higher mortality. The study objective was to characterize the relationship of age and injury duration with CMD.

Design

Retrospective cohort assessment of CMD risks using unbiased recursive partitioning to divide for group comparison: (1) Lowest Risk, (2) Moderate Risk, and (3) Highest Risk based on classification and regression trees predicting CMD diagnosis by age and injury duration.

Setting

Academic rehabilitation center laboratory.

Participants

Adults (N = 103; aged 18–75) with traumatic SCI (C4-L2) of 3 months to 42 years duration.

Interventions

NA.

Outcome measures

CMD risk factors (obesity, insulin resistance, dyslipidemia, and hypertension) using Paralyzed Veterans of America SCI-specific guidelines.

Results

Obesity was prevalent (82%) and co-occurred with most other risk factors present. Age increased odds for CMD diagnosis by 1.05 per year (P = 0.02) and was directly related to elevated body mass index (BMI, β = 0.42, P < 0.05), fasting glucose (β =  0.58, P < 0.01), and higher systolic blood pressure (β = 0.31, P < 0.10). In contrast, time since injury contributed to lower risk factor count (β = −0.29, P < 0.10) and higher HDL-C (β = 0.50, P < 0.01), and was not related to odds of CMD diagnosis.

Conclusion

While SCI is linked to an increased risk of CMD, age is associated with higher CMD risk. Increased SCI duration related to improvement in individual CMD risk factors but did not decrease overall risk for CMD diagnosis. SCI may not uniformly increase CMD risks and highlight a necessary focus on weight management for risk prevention.

Keywords:

• Cardiometabolic disease risk
• Obesity
• Spinal cord injury
• Aging
• Body mass index

Acknowledgements

The authors would like to acknowledge the generous support of our funding agencies, the study participants, and the exceptional staff at the Exercise for Persons with Disabilities program.

Disclaimer statements

Disclosure statement The authors have nothing to disclose, and no relationships with industry to disclose.

Data availability statement Part of the dataset generated during and analyzed in this study is not publicly available because it is still being analyzed, but the data can be made available from the senior author on reasonable request.

Funding This work was supported by Craig H. Neilsen Foundation: [Grant Number 542007]; National Institute on Disability, Independent Living, and Rehabilitation Research: [Grant Number 90SFGE0024-01-00]; National Institute on Disability, Independent Living, and Rehabilitation Research: [Grant Number 90SI5021]; National Institutes of Health: [Grant Number R01HL117037]; National Institutes of Health: [Grant Number 1K23HD102663-01].