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

Abstract

Study design Systematic review and meta-analysis. Objective To determine the difference in cardiovascular risk factors (blood pressure, lipid profile, and markers of glucose metabolism and inflammation) according to the neurological level of spinal cord injury (SCI). Methods We searched 5 electronic databases from inception until July 4, 2020. Data were extracted by two independent reviewers using a pre-defined data collection form. The pooled effect estimate was computed using random-effects models, and heterogeneity was calculated using I2 statistic and chi-squared test (CRD42020166162). Results We screened 4863 abstracts, of which 47 studies with 3878 participants (3280 males, 526 females, 72 sex unknown) were included in the meta-analysis. Compared to paraplegia, individuals with tetraplegia had lower systolic and diastolic blood pressure (unadjusted weighted mean difference, −14.5 mmHg, 95% CI −19.2, −9.9; −7.0 mmHg 95% CI −9.2, −4.8, respectively), lower triglycerides (−10.9 mg/dL, 95% CI −19.7, −2.1), total cholesterol (−9.9 mg/dL, 95% CI −14.5, −5.4), high-density lipoprotein (−1.7 mg/dL, 95% CI −3.3, −0.2) and low-density lipoprotein (−5.8 mg/dL, 95% CI −9.0, −2.5). Comparing individuals with high- vs. low-thoracic SCI, persons with higher injury had lower systolic and diastolic blood pressure (−10.3 mmHg, 95% CI −13.4, −7.1; −5.3 mmHg 95% CI −7.5, −3.2, respectively), while no differences were found for low-density lipoprotein, serum glucose, insulin, and inflammation markers. High heterogeneity was partially explained by age, prevalent cardiovascular diseases and medication use, body mass index, sample size, and quality of studies. Conclusion In SCI individuals, the level of injury may be an additional non-modifiable cardiovascular risk factor. Future well-designed longitudinal studies with sufficient follow-up and providing sex-stratified analyses should confirm our findings and explore the role of SCI level in cardiovascular health and overall prognosis and survival.

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

“…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.…”

“…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 …”

“…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.…”

“…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][10][11][12][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][16][17][18] Previous studies have shown increasing fat accumulation as early as 3 to 6 months post-injury (during the first inpatient rehabilitation hospitalization).…”

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

“…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).…”