Abstract
Study design:
Cross-sectional.
Objectives:
Individuals with spinal cord injury (SCI) exhibit increased carotid intima-media thickness (IMT) and are reported to be exposed to higher circulating levels of inflammatory mediators. This study evaluated the relationship between inflammatory markers and carotid surrogates of cardiovascular risk in subjects with SCI.
Setting:
São Paulo, Brazil.
Methods:
A total of 65 nondiabetic, nonhypertensive, sedentary, nonsmoker men (34 with SCI; 31 healthy subjects) were evaluated by medical history, anthropometry, routine laboratory tests, analysis of hemodynamic, inflammatory parameters and ultrasound examination of carotid arteries.
Results:
Subjects with SCI (18 tetraplegic and 16 paraplegic) had lower systolic blood pressure (P=0.009), higher serum C-reactive protein (P=0.001), tumor necrosis factor (TNF) receptor-II (P=0.02) and TNF receptor-I (P=0.04) levels and increased in vitro production of interleukin-6 by mononuclear cells (P=0.04), compared to able-bodied individuals. No differences in serum interleukin-6, e-selectin, intercellular adhesion molecule-1, vascular cell adhesion molecule-1 and transforming growth factor-β levels, or in vitro release of interleukin-10, interleukin-17 and interferon-γ by mononuclear cells, were detected between the studied groups. Common carotid IMT, but not internal carotid resistive index, was significantly higher in subjects with SCI (P<0.0001 adjusted for C-reactive protein and TNF receptor-II levels). In addition, tetraplegic subjects exhibited increased IMT (P=0.002 adjusted for systolic blood pressure and body mass index), but similar levels of inflammatory mediators compared to paraplegic ones.
Conclusions:
Individuals with SCI exhibit a clustering of vascular and inflammatory surrogates of increased cardiovascular risk. Nevertheless, subclinical carotid atherosclerosis is related to injury level but not to increased inflammatory status in these subjects.
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References
Hartkopp A, Bronnum-Hansen H, Seidenschnur AM, Biering-Sorensen F . Survival and cause of death after traumatic spinal cord injury. A long-term epidemiological survey from Denmark. Spinal Cord 1997; 35: 76–85.
Myers J, Lee M, Kiratli J . Cardiovascular disease in spinal cord injury: an overview of prevalence, risk, evaluation, and management. Am J Phys Med Rehabil 2007; 86: 142–152.
Matos-Souza JR, Pithon KR, Ozahata TM, Gemignani T, Cliquet Jr A, Nadruz Jr W . Carotid intima-media thickness is increased in patients with spinal cord injury independent of traditional cardiovascular risk factors. Atherosclerosis 2009; 202: 29–31.
Baldassarre D, De Jong A, Amato M, Werba JP, Castelnuovo S, Frigerio B et al. Carotid intima-media thickness and markers of inflammation, endothelial damage and hemostasis. Ann Med 2008; 40: 21–44.
Davies AL, Hayes KC, Dekaban GA . Clinical correlates of elevated serum concentrations of cytokines and autoantibodies in patients with spinal cord injury. Arch Phys Med Rehabil 2007; 88: 1384–1393.
Gibson AE, Buchholz AC, Martin Ginis KA . C-reactive protein in adults with chronic spinal cord injury: increased chronic inflammation in tetraplegia vs paraplegia. Spinal Cord 2008; 46: 616–621.
Wang TD, Wang YH, Huang TS, Su TC, Pan SL, Chen SY . Circulating levels of markers of inflammation and endothelial activation are increased in men with chronic spinal cord injury. J Formos Med Assoc 2007; 106: 919–928.
Fernandes JL, Mamoni RL, Orford JL, Garcia C, Selwyn AP, Coelho OR et al. Increased Th1 activity in patients with coronary artery disease. Cytokine 2004; 26: 131–137.
Staub D, Meyerhans A, Bundi B, Schmid HP, Frauchiger B . Prediction of cardiovascular morbidity and mortality: comparison of the internal carotid artery resistive index with the common carotid artery intima-media thickness. Stroke 2006; 37: 800–805.
Huang ZS, Chiang BL, Hsu KL . Serum level of soluble tumor necrosis factor receptor II (sTNF-R75) is apparently an index of overall monocyte-related infectious and inflammatory activity. Am J Med Sci 2000; 320: 183–187.
Gonzalez-Gay MA, Gonzalez-Juanatey C, Piñeiro A, Garcia-Porrua C, Testa A, Llorca J . High-grade C-reactive protein elevation correlates with accelerated atherogenesis in patients with rheumatoid arthritis. J Rheumatol 2005; 32: 1219–1223.
Segal JL, Gonzales E, Yousefi S, Jamshidipour L, Brunnemann SR . Circulating levels of IL-2R, ICAM-1, and IL-6 in spinal cord injuries. Arch Phys Med Rehabil 1997; 78: 44–47.
Spence JD . Technology Insight: ultrasound measurement of carotid plaque—patient management, genetic research, and therapy evaluation. Nat Clin Pract Neurol 2006; 2: 611–619.
Groah SL, Weitzenkamp D, Sett P, Soni B, Savic G . The relationship between neurological level of injury and symptomatic cardiovascular disease risk in the aging spinal injured. Spinal Cord 2001; 39: 310–317.
Lee CS, Lu YH, Lee ST, Lin CC, Ding HJ . Evaluating the prevalence of silent coronary artery disease in asymptomatic patients with spinal cord injury. Int Heart J 2006; 47: 325–330.
Orakzai SH, Orakzai RH, Ahmadi N, Agrawal N, Bauman WA, Yee F et al. Measurement of coronary artery calcification by electron beam computerized tomography in persons with chronic spinal cord injury: evidence for increased atherosclerotic burden. Spinal Cord 2007; 45: 775–779.
Jae SY, Heffernan KS, Lee M, Fernhall B . Arterial structure and function in physically active persons with spinal cord injury. J Rehabil Med 2008; 40: 535–538.
Leung FP, Yung LM, Laher I, Yao X, Chen ZY, Huang Y . Exercise, vascular wall and cardiovascular diseases: an update (Part 1). Sports Med 2008; 38: 1009–1024.
Frauchiger B, Schmid HP, Roedel C, Moosmann P, Staub D . Comparison of carotid arterial resistive indices with intima-media thickness as sonographic markers of atherosclerosis. Stroke 2001; 32: 836–841.
Myers GL, Rifai N, Tracy RP, Roberts WL, Alexander RW, Biasucci LM et al. CDC/AHA Workshop on Markers of Inflammation and Cardiovascular Disease: Application to Clinical and Public Health Practice: report from the laboratory science discussion group. Circulation 2004; 110: e545–e549.
Acknowledgements
This work was supported by grants from FAPESP (Proc. 05/56986-5 and 07/55148-1) and CNPq (Proc. 304329/06-1 and 474206/07-6), Brazil. We thank Dr Nicola Conran for English language editing.
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Matos-Souza, J., Pithon, K., Ozahata, T. et al. Subclinical atherosclerosis is related to injury level but not to inflammatory parameters in spinal cord injury subjects. Spinal Cord 48, 740–744 (2010). https://doi.org/10.1038/sc.2010.12
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DOI: https://doi.org/10.1038/sc.2010.12
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