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Titre : | Cardiometabolic Syndrome in People With Spinal Cord Injury/Disease: Guideline-Derived and Nonguideline Risk Components in a Pooled Sample (2016) |
Auteurs : | Mark S. Nash ; Rochelle E. Tractenberg ; Armando J. Mendez |
Type de document : | Article |
Dans : | Archives of Physical Medicine and Rehabilitation (2016/10, 2016) |
Article en page(s) : | pp. 16961705 |
Langues: | Anglais |
Descripteurs : |
HE Vinci Diabète de type 2 ; Rééducation et réadaptation ; Traumatismes de la moelle épinière |
Mots-clés: | Diabetes mellitus ; type 2 ; Endocrine system diseases ; Maladies endocriniennes ; Obesity ; abdominal ; Obésité abdominale ; Spinal cord injuries |
Résumé : |
Objective To assess cardiometabolic syndrome (CMS) risk definitions in spinal cord injury/disease (SCI/D). Design Cross-sectional analysis of a pooled sample. Setting Two SCI/D academic medical and rehabilitation centers. Participants 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 AD). Interventions Not applicable. Main Outcome Measures 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. Results 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, χ2=10.105; adjusted P=.008). Insulin resistance was significantly associated with CMS when using the HOMA2/QUICKI model (χ22=21.23, adjusted P<.001 of the subjects were at moderate to high risk from elevated crp which was significantly associated with cms determination methods sum risks adjusted p=".048" and homa2> Conclusions 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. |
Disponible en ligne : | Oui |
En ligne : | https://login.ezproxy.vinci.be/login?url=https://www.sciencedirect.com/science/article/pii/S0003999316303410 |