Abstract
Study design:
Cross-sectional.
Objectives:
In community-dwelling adults with chronic spinal cord injury (SCI), to (1) quantify C-reactive protein (CRP), a marker of inflammation and cardiovascular disease (CVD) risk; (2) determine factors associated with CRP.
Setting:
Hamilton, Ontario, Canada.
Methods:
We examined CVD risk factors in 69 participants. Measurements included length, weight, waist circumference, blood pressure, percent fat mass (bioelectrical impedance analysis) and fasting blood parameters (high-sensitivity CRP, lipids, insulin, glucose, insulin resistance by homeostasis model assessment (HOMA)).
Results:
Mean CRP of the group was 3.37±2.86 mg−l−1, consistent with the American Heart Association (AHA) definition of high risk of CVD. CRP was 74% higher in persons with tetraplegia (4.31±2.97) than those with paraplegia (2.47±2.47 mg l−1, P=0.002), consistent with high CVD risk. Participants with high CRP (3.1–9.9 mg l−1) had greater waist circumference, BMI, percent fat mass and HOMA values than those with lower CRP (⩽3.0 mg l−1, all P<0.05). LogCRP was independently correlated with waist circumference (r=0.612), logTriglycerides (r=0.342), logInsulin (r=0.309) and logHOMA (r=0.316, all P<0.05). Only level of lesion and waist circumference remained significantly associated with logCRP when variables with significant bivariate correlations were included in multiple regression analysis.
Conclusion:
Mean CRP values in this sample of adults with chronic SCI were consistent with the AHA classification of high CVD risk, especially those of persons with tetraplegia. Level of lesion and waist circumference are independently associated with CRP in this population.
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References
Strauss DJ, Devivo MJ, Paculdo DR, Shavelle RM . Trends in life expectancy after spinal cord injury. Arch Phys Med Rehabil 2006; 87: 1079–1085.
Lavela SL, Weaver FM, Goldstein B, Chen K, Miskevics S, Rajan S et al. Diabetes mellitus in individuals with spinal cord injury or disorder. J Spinal Cord Med 2006; 29: 387–395.
Lipscombe LL, Hux JE . Trends in diabetes prevalence, incidence, and mortality in Ontario, Canada 1995–2005: a population-based study. Lancet 2007; 369: 750–756.
American Heart Association. Leading Causes of Death—Statistics [article online]. 2004. Available from http://www.americanheart.org/downloadable/heart/1136822094308LeadingCauses06.pdf. Accessed 05 April 2007.
Garshick E, Kelley A, Cohen SA, Garrison A, Tun CG, Gagnon D et al. A prospective assessment of mortality in chronic spinal cord injury. Spinal Cord 2005; 43: 408–416.
Demirel S, Demirel G, Tukek T, Erk O, Yilmaz H . Risk factors for coronary heart disease in patients with spinal cord injury in Turkey. Spinal Cord 2001; 39: 134–138.
Buchholz AC, Bugaresti JM . A review of body mass index and waist circumference as markers of obesity and coronary heart disease risk in persons with chronic spinal cord injury. Spinal Cord 2005; 43: 513–518.
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.
Libby P . Inflammation in atherosclerosis. Nature 2002; 420: 868–874.
Rutter MK, Meigs JB, Sullivan LM, D’Agostino Sr RB, Wilson PW . C-reactive protein, the metabolic syndrome, and prediction of cardiovascular events in the Framingham Offspring Study. Circulation 2004; 110: 380–385.
Sattar N, Gaw A, Scherbakova O, Ford I, O’Reilly DS, Haffner SM et al. Metabolic syndrome with and without C-reactive protein as a predictor of coronary heart disease and diabetes in the West of Scotland Coronary Prevention Study. Circulation 2003; 108: 414–419.
Pearson TA, Mensah GA, Alexander RW, Anderson JL, Cannon III RO, Criqui M et al. Markers of inflammation and cardiovascular disease: application to clinical and public health practice: a statement for healthcare professionals from the Centers for Disease Control and Prevention and the American Heart Association. Circulation 2003; 107: 499–511.
Manns PJ, McCubbin JA, Williams DP . Fitness, inflammation, and the metabolic syndrome in men with paraplegia. Arch Phys Med Rehabil 2005; 86: 1176–1181.
Lee MY, Myers J, Hayes A, Madan S, Froelicher VF, Perkash I et al. C-reactive protein, metabolic syndrome, and insulin resistance in individuals with spinal cord injury. J Spinal Cord Med 2005; 28: 20–25.
Frost F, Roach MJ, Kushner I, Schreiber P . Inflammatory C-reactive protein and cytokine levels in asymptomatic people with chronic spinal cord injury. Arch Phys Med Rehabil 2005; 86: 312–317.
Martin Ginis KA, Latimer AE, Buchholz AC, Bray SR, Craven BC, Hayes KC et al. Establishing evidence-based physical activity guidelines: methods for the Study of Health and Activity in People with Spinal Cord Injury (SHAPE SCI). Spinal Cord 2008; 46: 216–221.
Chumlea WC, Guo SS, Kuczmarski RJ, Flegal KM, Johnson CL, Heymsfield SB et al. Body composition estimates from NHANES III bioelectrical impedance data. Int J Obes 2002; 26: 1596–1609.
Friedewald WT, Levy RI, Fredrickson DS . Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clin Chem 1972; 6: 499–502.
Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, Turner RC . Homeostasis model assessment: Insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia 1985; 28: 412–419.
National Spinal Cord Injury Statistical Center. The 2006 Annual Statistical Report for the Model Spinal Cord Injury Care Systems [Internet]. University of Alabama at Birmingham, National Spinal Cord Injury Statistical Center: Birmingham (AB); 2006 [cited 2007 Aug 27]. Available from: http://images.main.uab.edu/spinalcord/pdffiles/NSCIC%20Annual%2006.pdf.
Rexrode KM, Pradhan A, Manson JE, Buring JE, Ridker PM . Relationship of total and abdominal adiposity with CRP and IL-6 in women. Ann Epidemiol 2003; 13: 674–682.
Bonora E, Formentini G, Calcaterra F, Lombardi S, Marini F, Zenari L et al. HOMA-estimated insulin resistance is an independent predictor of cardiovascular disease in type 2 diabetic subjects. Diabetes Care 2002; 25: 1135–1141.
Acknowledgements
We thank the participants of the SHAPE SCI study and Rebecca Bassett and Iwona Chudzik for their help with data collection. The study was funded by the Canadian Institutes for Health Research.
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Gibson, A., Buchholz, A., Martin Ginis, K. et al. C-Reactive protein in adults with chronic spinal cord injury: increased chronic inflammation in tetraplegia vs paraplegia. Spinal Cord 46, 616–621 (2008). https://doi.org/10.1038/sc.2008.32
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DOI: https://doi.org/10.1038/sc.2008.32
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