title: Cardiometabolic Syndrome in People With Spinal Cord Injury/Disease: Guideline-Derived and Nonguideline Risk Components in a Pooled Sample.
abstract: To assess cardiometabolic syndrome (CMS) risk definitions in spinal cord injury/disease (SCI/D).
  
  
  
  Cross-sectional analysis of a pooled sample.
  
  
  
  Two SCI/D academic medical and rehabilitation centers.
  
  
  
  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).
  
  
  
  Not applicable.
  
  
  
  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.
  
  
  
  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, χ(2)=10.105; adjusted P=.008). Insulin resistance was significantly associated with CMS when using the HOMA2/QUICKI model (χ(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, χ(2)2=10.198; adjusted P=.048 and HOMA2/QUICKI, χ(2)2=10.532; adjusted P=.04).
  
  
  
  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.
authors.affiliation: Department of Neurological Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, FL; Department of Physical Medicine and Rehabilitation, and Medicine, Leonard M. Miller School of Medicine, University of Miami, Miami, FL; The Miami Project to Cure Paralysis, Leonard M. Miller School of Medicine, University of Miami, Miami, FL. Electronic address: mnash@med.miami.edu.
authors.forename: Mark S
authors.initials: MS
authors.lastname: Nash
authors.affiliation: Collaborative for Research on Outcomes and Metrics, Georgetown University Medical Center, Washington, DC; Department of Neurology, Georgetown University Medical Center, Washington, DC; Department of Biostatistics, Bioinformatics and Biomathematics, Georgetown University Medical Center, Washington, DC; Department of Rehabilitation Medicine, Georgetown University Medical Center, Washington, DC.
authors.forename: Rochelle E
authors.initials: RE
authors.lastname: Tractenberg
authors.affiliation: Department of Medicine, Leonard M. Miller School of Medicine, University of Miami, Miami, FL; Diabetes Research Institute, Leonard M. Miller School of Medicine, University of Miami, Miami, FL.
authors.forename: Armando J
authors.initials: AJ
authors.lastname: Mendez
authors.affiliation: The Miami Project to Cure Paralysis, Leonard M. Miller School of Medicine, University of Miami, Miami, FL.
authors.forename: Maya
authors.initials: M
authors.lastname: David
authors.affiliation: MedStar National Rehabilitation Hospital, Washington, DC.
authors.forename: Inger H
authors.initials: IH
authors.lastname: Ljungberg
authors.affiliation: MedStar National Rehabilitation Hospital, Washington, DC.
authors.forename: Emily A
authors.initials: EA
authors.lastname: Tinsley
authors.affiliation: The Miami Project to Cure Paralysis, Leonard M. Miller School of Medicine, University of Miami, Miami, FL.
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Burns-Drecq
authors.affiliation: The Miami Project to Cure Paralysis, Leonard M. Miller School of Medicine, University of Miami, Miami, FL.
authors.forename: Luisa F
authors.initials: LF
authors.lastname: Betancourt
authors.affiliation: MedStar National Rehabilitation Hospital, Washington, DC.
authors.forename: Suzanne L
authors.initials: SL
authors.lastname: Groah
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001794:Blood Pressure; D001835:Body Weight; D003430:Cross-Sectional Studies; D005260:Female; D006442:Glycated Hemoglobin; D006801:Humans; D018836:Inflammation Mediators / Q000097:blood; D007333:Insulin Resistance; D008055:Lipids / Q000097:blood; D008297:Male; D024821:Metabolic Syndrome / Q000453:epidemiology*; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D012307:Risk Factors; D013118:Spinal Cord Diseases / Q000453:epidemiology*; D013119:Spinal Cord Injuries / Q000145:classification / Q000453:epidemiology*; D015599:Trauma Severity Indices; D055815:Young Adult
chemical_list: D006442:Glycated Hemoglobin; D018836:Inflammation Mediators; D008055:Lipids
keywords: Diabetes mellitus, type 2; Endocrine system diseases; Obesity, abdominal; Rehabilitation; Spinal cord injuries