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

Abstract

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.

The burden of cardiovascular risk in individuals with spinal cord injury (SCI) and its association with rehabilitation outcomes – Results from the Swiss SCI Cohort

“…Although CVDs have been recognized as an increasingly important cause of mortality, 57,58 cardiovascular screening may not be a medical priority before discharge. A retrospective assessment of hospital records participating in SwiSCI showed that only one fifth of the study population was screened for lipid profile (51), even though more than one third may be at increased CVD risk and 39.5% met criteria for metabolic syndrome 4 . Our study revealed that higher rehabilitation outcomes relate to better cardiovascular health.…”

“…Understanding these changes during inpatient rehabilitation could be important in cardiovascular disease (CVD) prevention because deterioration in lipid or glucose profile could lead to long-term complications and morbidity 13 . In a previous study, at discharge from initial rehabilitation, almost one third of patients can be classified as high risk for CVD 4 . Despite being considered for a high CVD risk group because of risk factors clustering as early as within weeks after injury, 14,15 CVD screening has not been routinely included before rehabilitation discharge 16,17 .…”

“…Despite being considered for a high CVD risk group because of risk factors clustering as early as within weeks after injury, 14,15 CVD screening has not been routinely included before rehabilitation discharge 16,17 . Previous study has shown 20% of individuals with SCI are being screened for lipid profile and fasting glucose upon discharge 18 even though 30%–60% of them are at high cardiovascular risk 4 . The main determinants of poorer CVD risk profile in subacute injury phase remain largely unknown.…”

“…A recent study on the subacute phase observed no deterioration of cardiovascular health during inpatient rehabilitation. 4 Thus, the inpatient rehabilitation program could have a beneficial effect on cardiometabolic health.…”

“…13 In a previous study, at discharge from initial rehabilitation, almost one third of patients can be classified as high risk for CVD. 4 Despite being considered for a high CVD risk group because of risk factors clustering as early as within weeks after injury, 14,15 CVD screening has not been routinely included before rehabilitation discharge. 16,17 Previous study has shown 20% of individuals with SCI are being screened for lipid profile and fasting glucose upon discharge 18 even though 30%-60% of them are at high cardiovascular risk.…”