Cardiometabolic Syndrome in People with Spinal Cord Injury/Disease: Guideline-derived and Non-Guideline Risk Components in a Pooled Sample

Abstract Objective 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 seven clinical studies were pooled; not all variables were collected in all studies so that participant numbers varied from 119-389. The pooled sample included males (79%) and females (21%) with SCI/D >1 year at spinal cord levels spanning C3-T2 (AIS A-D). Interventions Not applicable. Main Outcome Measures We computed the prevalence of CMS using the American Heart Association (AHA)/National Heart Lung Blood Institute (NHLBI) guideline (CMS diagnosis as sum-of-risks (SUM-OF-RISKS) ≥ 3) for the following risk components: overweight/obesity, insulin resistance, hypertension, and dyslipidemia. We compared this prevalence with the risk calculated from two routinely used non-guideline 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 upon an inflammation (C-Reactive Protein [CRP]) - adjusted Total Cholesterol (TC): High-density Lipoprotein Cholesterol (HDL-C) ratio. Results After adjustment for multiple comparisons, injury level and AIS were unrelated to CMS or risk factors. 13% and 32.1% of participants 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=0.008). Insulin resistance was significantly associated with CMS when using the HOMA2/QUICKI model (χ2 (2) =21.23, adjusted p