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Traditional cardiovascular risk factors strongly underestimate the 5-year occurrence of cardiovascular morbidity and mortality in spinal cord injured individuals

Low, DA, Thijssen, DHJ, Barton, T, Janssen, T, Bakker, EA, de Groot, S and van der Woude, L Traditional cardiovascular risk factors strongly underestimate the 5-year occurrence of cardiovascular morbidity and mortality in spinal cord injured individuals. Archives of Physical Medicine and Rehabilitation. ISSN 0003-9993 (Accepted)

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Abstract

Objective– To explore whether traditional models of cardiovascular disease (CVD) risk prediction correctly predict CVD events across a median 5.7-year follow-up in people with spinal cord injury (SCI), and if adding SCI-related characteristics (i.e. lesion level) to the prediction model can improve the prognostic value.

Design– Retrospective analysis of patient records.

Setting – Observation at the start of active rehabilitation of participants in a multicenter cohort study, ‘Restoration of (wheelchair) mobility in SCI rehabilitation’, in the Netherlands.

Participants – Patients with SCI (n=200; 74% male, 40±14 years, ASIA impairment A-D, tetraplegia 40%, motor complete 69%).
Interventions - risk profiling/not applicable.

Main Outcome Measures - Survival status and cardiovascular morbidity and mortality were obtained from medical records. 5-year Framingham Risk Scores (FRS) and the FRS ability to predict events assessed using receiver operating characteristics curves (ROC) with corresponding area under the curves (AUC) and 95% CIs. Kaplan–Meier curves and the log- rank test were used to assess the difference in clinical outcome between participants with a FRS > and < median FRS score for the cohort. SCI-related factors associated with CVD-events, ASIA impairment, motor completeness, level of injury and sports participation prior to injury, were explored using univariate and multivariate Cox proportional hazard regression.

Results - The median 5-year FRS was 1.36%. Across a median follow-up of 5.7-years, n=39 developed a CVD event, including 10 fatalities. Although the FRS markedly underestimated the true occurrence of CVD events, the Kaplan–Meier curves and the log-rank test showed that the risk ratio for individuals with a <median FRS (e.g., low-risk) vs. a >median FRS (high-risk) was 3.2 (95% CI 1.6-6.5; p=0.001). Moreover, receiver operating characteristics curves (ROC) with corresponding area under the curves (AUC) suggests acceptable accuracy of the FRS to identify individuals with increased risk for future CVD events (ROC-AUC of 0.71, 95%-Confidence Interval(CI) 0.62-0.82). Adding ASIA impairment (0.74; 95% CI 0.66-0.82), motor impairment (0.74; 95% CI 0.66-0.83), level of injury (0.72; 95% CI 0.63-0.81) or active engagement in sport prior to injury (0.72; 95% CI 0.63-0.88) to the FRS did not improve the level of discrimination.

Item Type: Article
Uncontrolled Keywords: 1103 Clinical Sciences, 1106 Human Movement and Sports Sciences, 1117 Public Health and Health Services
Subjects: Q Science > QP Physiology
R Medicine > RC Internal medicine > RC1200 Sports Medicine
Divisions: Sport & Exercise Sciences
Publisher: Elsevier
Date Deposited: 24 Jul 2020 15:00
Last Modified: 24 Jul 2020 15:00
URI: https://researchonline.ljmu.ac.uk/id/eprint/13384

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