The Prevalence of and Contributed Risk Factors of Cardiovascular Diseases among People with Spinal Cord Injury: A Retrospective Study Ramzi Alajam

Outlines Background Objective Methods Results Conclusion Limitations and future direction

Background Spinal cord injury (SCI) Loss of motor and sensory function Quality of life Secondary complications Complete vs. incomplete Traumatic vs. non-traumatic SCI More prevalent in men and young population

Background Cardiovascular disease (CVD) The main leading cause of death among SCI population 30-50% in SCI population compared to 5-10% in able-bodied population 17% heart disease in individuals with SCI compared to 5% in those without SCI 6% stroke in individuals with SCI compared to 1.1% in those without SCI

Chronic inflammatory status Background Hypertension Chronic inflammatory status Dyslipidemia Smoking Diabetes Overweight & obesity

Questions Are the prevalence rates of CVD different between Quadriplegic versus paraplegic people? People with complete versus incomplete? Which of risk factors contribute significantly in the development of CVD among SCI population?

Objectives To estimate the prevalence rates of heart disease and stroke among people with SCI based on the level and severity of injury. To determine risk factors that contribute to increase the risk of heart diseases or stroke following SCI.

Methods Retrospective study using HERON databases at KUMC Cohort patients with SCI and diagnosis of Heart diseases (ischemic heart diseases or heart failure) Stroke (ischemic or hemorrhagic stroke) Diagnosis code of ICD-9 and-10

Methods Target cohort and variables of interest Target cohort Another query which included target cohort and factors of interest was built. Diabetes, hypertension, and dyslipidemia were identified using ICD 9 and 10

Methods Variables of interest: Hypertension, diabetes, dyslipidemia (ICD-9 and-10) Elevated C-reactive protein (laboratory test) Smoking status and BMI (medical history and visit details)

Methods

Data and Statistical Analysis SQLite database Brower Descriptive statistical analysis

Results Overall prevalence of heart diseases and stroke 12 % had heart diseases 11 % had stroke Heart diseases No heart diseases Total SCI 482 3686 4168 Stroke No stroke Total SCI 452 3816 4268

Results Prevalence rate based on level of injury Stroke: 13% in quadriplegia vs. 8% in paraplegia Heart diseases: 10% in quadriplegia vs. 12% in paraplegia The odd ratio of heart diseases was 1.2 times higher in paraplegic people compared to quadriplegic people The odd ratio of stroke was 1.7 times higher in quadriplegic people compared to paraplegic people Level of SCI Heart diseases No heart diseases Total Quadriplegia 198 1698 1896 Paraplegia 335 2404 2739 Level of SCI Stroke No stroke Total Quadriplegia 244 1677 1921 Paraplegia 225 2561 2786

Results Prevalence rate based on severity of injury The prevalence rates of heart diseases and stroke were almost same between people with complete vs. incomplete Heart diseases: 12.2% in complete SCI vs. 12.5% in incomplete SCI Stroke: 10.5% in complete SCI vs. 10.7% in incomplete SCI Severity of SCI Heart diseases No heart diseases Total Complete 34 244 278 Incomplete 47 329 376 Severity of SCI Stroke No stroke Total Complete 29 246 275 Incomplete 42 350 392

The average time of developing heart diseases was 3.78 years Result In 326 individuals (mean age= 60 year-old ; gender(f) = 189(137)) The average time of developing heart diseases was 3.78 years

The average time of developing stroke was 3.23 years Results In 248 individuals (mean age = 60±17; gender (F) = 137(111)) The average time of developing stroke was 3.23 years

Conclusion: The prevalence rate of heart diseases High in paraplegic people than quadriplegic people No difference between complete vs. incomplete The prevalence rate of stroke High in quadriplegic people than paraplegic people Development of heart diseases and stroke following SCI Hypertension, and overweight & obesity.

Limitations Limited information about: Physical activity and mobility status Severity of injury

Future Direction Investigate the effect of reducing or preventing these risk factors on the development of heart diseases or stroke.

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