Objectives

To (1) describe the prevalence of cardiometabolic disease (CMD) at spinal cord injury (SCI) rehabilitation discharge; (2) compare this with controls without SCI; and (3) identify factors associated with increased CMD.

Design

Multicenter, prospective observational study.

Setting

Five National Institute on Disability, Independent Living, and Rehabilitation Research Model SCI Rehabilitation Centers.

Participants

SCI (n=95): patients aged 18-70 years, with SCI (neurologic levels of injury C2-L2, American Spinal Injury Association Impairment Scale grades A-D), and enrolled within 2 months of initial rehabilitation discharge. Control group (n=1609): age/sex/body mass index–matched entries in the National Health and Nutrition Examination Education Survey (2016-2019) (N=1704).

Interventions

None

Main Outcome Measures

Percentage of participants with SCI with CMD diagnosis, prevalence of CMD determinants within 2 months of rehabilitation discharge, and other significant early risk associations were analyzed using age, sex, body mass index, insulin resistance (IR) by fasting glucose and Homeostasis Model Assessment (v.2), fasting triglycerides, high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol, total cholesterol, and resting blood pressure (systolic and diastolic).

Results

Participants with SCI had significantly higher diastolic blood pressure and triglycerides than those without SCI, with lower fasting glucose and HDL-C. A total of 74.0% of participants with SCI vs 38.5% of those without SCI were obese when applying population-specific criteria (P<.05). Low HDL-C was measured in 54.2% of participants with SCI vs 15.4% of those without (P<.05). IR was not significantly different between groups. A total of 31.6% of participants with SCI had ≥3 CMD determinants, which was 40.7% higher than those without SCI (P<.05). Interplay of lipids and lipoproteins (ie, total cholesterol:HDL-C ratio and triglyceride:HDL-C ratio) were associated with elevated risk in participants with SCI for myocardial infarction and stroke. The only significant variable associated with CMD was age (P<.05).

Conclusions

Individuals with SCI have an increased CMD risk compared with the general population; obesity, IR, and low HDL-C are the most common CMD risk determinants; age is significantly associated with early CMD.

中文翻译：

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急性脊髓损伤与普遍的心脏代谢危险因素有关

 目标

(1) 描述脊髓损伤 (SCI) 康复出院时心脏代谢疾病 (CMD) 的患病率； (2) 与没有 SCI 的对照进行比较； (3) 确定与 CMD 增加相关的因素。

 设计

多中心、前瞻性观察研究。

 环境

五个国家残疾、独立生活和康复研究所模型 SCI 康复中心。

 参加者

SCI (n=95)：年龄 18-70 岁、患有 SCI 的患者（损伤神经学水平 C2-L2，美国脊柱损伤协会损伤量表 AD 级），并在初次康复出院后 2 个月内入组。对照组（n=1609）：年龄/性别/体重指数匹配的全国健康与营养考试教育调查（2016-2019）条目（N=1704）。

 干预措施

 没有任何

 主要成果指标

使用年龄、性别、体重指数、空腹血糖和稳态模型评估的胰岛素抵抗 (IR) 来分析患有 CMD 诊断的 SCI 参与者的百分比、康复出院 2 个月内 CMD 决定因素的患病率以及其他显着的早期风险关联。 v.2)、空腹甘油三酯、高密度脂蛋白胆固醇 (HDL-C) 和低密度脂蛋白胆固醇、总胆固醇和静息血压（收缩压和舒张压）。

 结果

患有 SCI 的参与者的舒张压和甘油三酯显着高于未患有 SCI 的参与者，而空腹血糖和 HDL-C 较低。当应用特定人群标准时，共有 74.0% 的 SCI 参与者和 38.5% 的非 SCI 参与者肥胖 ( P <.05)。患有 SCI 的参与者中有 54.2% 的 HDL-C 水平较低，而没有 SCI 的参与者则为 15.4% ( P <.05)。 IR 在组间没有显着差异。共有 31.6% 的 SCI 参与者具有≥3 个 CMD 决定因素，比非 SCI 参与者高 40.7% ( P <.05)。脂质和脂蛋白的相互作用（即总胆固醇：HDL-C 比率和甘油三酯：HDL-C 比率）与 SCI 参与者心肌梗死和中风的风险升高相关。与 CMD 相关的唯一显着变量是年龄 ( P <.05)。

 结论

与一般人群相比，SCI 患者的 CMD 风险更高；肥胖、IR 和低 HDL-C 是最常见的 CMD 风险决定因素；年龄与早期 CMD 显着相关。