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Coronary and Carotid Imaging of Atherosclerosis and Contributing Factors in Middle-aged People with Long-term Cervical and Upper Thoracic Spinal Cord Injuries

Hill, Mattias LU orcid ; Jörgensen, Sophie LU ; Engström, Gunnar LU ; Persson, Margaretha LU orcid and Lexell, Jan LU (2023) In PM and R
Abstract

INTRODUCTION: Cardiovascular disease (CVD) is a major cause of death in people aging with spinal cord injury (SCI), and is predominantly caused by atherosclerosis, however, knowledge of atherosclerosis in people with SCI is scarce.

OBJECTIVE: To describe coronary and carotid atherosclerosis in middle-aged people with long-term cervical and upper thoracic SCI using coronary computed tomography angiography, carotid ultrasound, and CVD risk factors, and to compare with the general population.

DESIGN: Cross-sectional study with matched controls.

SETTING: Outpatient SCI unit in southern Sweden.

PARTICIPANTS: Participants (n=25) in the Swedish SPinal Cord Injury Study on Cardiopulmonary and Autonomic Impairment (SPICA)... (More)

INTRODUCTION: Cardiovascular disease (CVD) is a major cause of death in people aging with spinal cord injury (SCI), and is predominantly caused by atherosclerosis, however, knowledge of atherosclerosis in people with SCI is scarce.

OBJECTIVE: To describe coronary and carotid atherosclerosis in middle-aged people with long-term cervical and upper thoracic SCI using coronary computed tomography angiography, carotid ultrasound, and CVD risk factors, and to compare with the general population.

DESIGN: Cross-sectional study with matched controls.

SETTING: Outpatient SCI unit in southern Sweden.

PARTICIPANTS: Participants (n=25) in the Swedish SPinal Cord Injury Study on Cardiopulmonary and Autonomic Impairment (SPICA) (20% women, mean age 58 years, mean time since injury 28 years, injury levels C2-T6, American Spinal Injury Association Impairment Scale A-C). Non-SCI controls (n=125; ratio 5:1) from the Swedish CArdioPulmonary bioImage Study (SCAPIS).

INTERVENTIONS: Not applicable MAIN OUTCOME MEASURES: Presence of coronary atherosclerosis, coronary artery calcium score (CACS), carotid plaques, carotid intima media thickness, blood pressure, lipids, Systematic Coronary Risk Evaluation (SCORE) and anthropometry.

RESULTS: Coronary and carotid atherosclerotic plaques occurred in 44% of the participants, 67% of the controls exhibited coronary and 59% carotid plaques; odds ratios (OR; 95% CI): 0.38 (0.13-1.17) and 0.54 (0.22-1.32), respectively. Mean number of segments with coronary atherosclerosis were 1.0 in participants and 2.1 in controls (OR: 0.74 [0.52-1.06]). CACS >100 occurred in 4 (18%) of the participants and 23 (21%) of the controls. The participants had significantly lower levels of total and non-high density lipoprotein cholesterol and SCORE than the controls.

CONCLUSIONS: This is the first comprehensive assessment of atherosclerosis in people with SCI using advanced imaging techniques. The atherosclerotic burden in middle-aged people with long-term cervical and upper thoracic SCI was not increased, whereas SCORE was lower due to lower cholesterol levels. Imaging techniques may be valuable tools for assessment of atherosclerosis in SCI. This article is protected by copyright. All rights reserved.

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author
; ; ; and
organization
publishing date
type
Contribution to journal
publication status
epub
subject
in
PM and R
publisher
Wiley-Blackwell
external identifiers
  • scopus:85173040849
  • pmid:37492978
ISSN
1934-1563
DOI
10.1002/pmrj.13043
language
English
LU publication?
yes
additional info
This article is protected by copyright. All rights reserved.
id
9e889283-65cf-4f8e-8bb2-3d59c31f6231
date added to LUP
2023-09-12 22:38:56
date last changed
2024-04-19 00:52:43
@article{9e889283-65cf-4f8e-8bb2-3d59c31f6231,
  abstract     = {{<p>INTRODUCTION: Cardiovascular disease (CVD) is a major cause of death in people aging with spinal cord injury (SCI), and is predominantly caused by atherosclerosis, however, knowledge of atherosclerosis in people with SCI is scarce.</p><p>OBJECTIVE: To describe coronary and carotid atherosclerosis in middle-aged people with long-term cervical and upper thoracic SCI using coronary computed tomography angiography, carotid ultrasound, and CVD risk factors, and to compare with the general population.</p><p>DESIGN: Cross-sectional study with matched controls.</p><p>SETTING: Outpatient SCI unit in southern Sweden.</p><p>PARTICIPANTS: Participants (n=25) in the Swedish SPinal Cord Injury Study on Cardiopulmonary and Autonomic Impairment (SPICA) (20% women, mean age 58 years, mean time since injury 28 years, injury levels C2-T6, American Spinal Injury Association Impairment Scale A-C). Non-SCI controls (n=125; ratio 5:1) from the Swedish CArdioPulmonary bioImage Study (SCAPIS).</p><p>INTERVENTIONS: Not applicable MAIN OUTCOME MEASURES: Presence of coronary atherosclerosis, coronary artery calcium score (CACS), carotid plaques, carotid intima media thickness, blood pressure, lipids, Systematic Coronary Risk Evaluation (SCORE) and anthropometry.</p><p>RESULTS: Coronary and carotid atherosclerotic plaques occurred in 44% of the participants, 67% of the controls exhibited coronary and 59% carotid plaques; odds ratios (OR; 95% CI): 0.38 (0.13-1.17) and 0.54 (0.22-1.32), respectively. Mean number of segments with coronary atherosclerosis were 1.0 in participants and 2.1 in controls (OR: 0.74 [0.52-1.06]). CACS &gt;100 occurred in 4 (18%) of the participants and 23 (21%) of the controls. The participants had significantly lower levels of total and non-high density lipoprotein cholesterol and SCORE than the controls.</p><p>CONCLUSIONS: This is the first comprehensive assessment of atherosclerosis in people with SCI using advanced imaging techniques. The atherosclerotic burden in middle-aged people with long-term cervical and upper thoracic SCI was not increased, whereas SCORE was lower due to lower cholesterol levels. Imaging techniques may be valuable tools for assessment of atherosclerosis in SCI. This article is protected by copyright. All rights reserved.</p>}},
  author       = {{Hill, Mattias and Jörgensen, Sophie and Engström, Gunnar and Persson, Margaretha and Lexell, Jan}},
  issn         = {{1934-1563}},
  language     = {{eng}},
  month        = {{07}},
  publisher    = {{Wiley-Blackwell}},
  series       = {{PM and R}},
  title        = {{Coronary and Carotid Imaging of Atherosclerosis and Contributing Factors in Middle-aged People with Long-term Cervical and Upper Thoracic Spinal Cord Injuries}},
  url          = {{http://dx.doi.org/10.1002/pmrj.13043}},
  doi          = {{10.1002/pmrj.13043}},
  year         = {{2023}},
}