Cardiometabolic Syndrome in People With Spinal Cord Injury/Disease: Guideline-Derived and Nonguideline Risk Components in a Pooled Sample. 

 -  2016 
<br/><br/>Available online from MWHC library: 2000 - present, Available in print through MWHC library:1999-2007 
<br/><br/> 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.  Copyright � 2016 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.  DESIGN: Cross-sectional analysis of a pooled sample.  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.  OBJECTIVE: To assess cardiometabolic syndrome (CMS) risk definitions in spinal cord injury/disease (SCI/D).  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 A-D).  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, chi(2)=10.105; adjusted P=.008). Insulin resistance was significantly associated with CMS when using the HOMA2/QUICKI model (chi(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, chi(2)2=10.198; adjusted P=.048 and HOMA2/QUICKI, chi(2)2=10.532; adjusted P=.04).  SETTING: Two SCI/D academic medical and rehabilitation centers. 
<br/><br/><br/>English 
<br/><br/><label>ISSN: </label>0003-9993 
<br/><br/><label>Subjects--Topical Terms: </label><br/>*Metabolic Syndrome X/ep [Epidemiology]<br/>*Spinal Cord Diseases/ep [Epidemiology]<br/>*Spinal Cord Injuries/ep [Epidemiology]<br/>Adolescent<br/>Adult<br/>Aged<br/>Blood Pressure<br/>Body Weight<br/>Cross-Sectional Studies<br/>Female<br/>Hemoglobin A, Glycosylated<br/>Humans<br/>Inflammation Mediators/bl [Blood]<br/>Insulin Resistance<br/>Lipids/bl [Blood]<br/>Male<br/>Middle Aged<br/>Practice Guidelines as Topic<br/>Risk Factors<br/>Spinal Cord Injuries/cl [Classification]<br/>Trauma Severity Indices<br/>Young Adult
<br/><br/><label>Subjects--Geographic Terms: </label><br/>MedStar National Rehabilitation Network<br/>MedStar Washington Hospital Center
<br/><br/><label>Index Terms--Occupation: </label><br/>Physical Medicine and Rehabilitation
<br/><br/><label>Index Terms--Function: </label><br/>Journal Article