Cardiovascular disease (CVD) is linked to a variety of cardiometabolic (CM) risk factors in the general population, primarily overweight/obesity, atherogenic dyslipidemia, hypertension, and insulin resistance. More recently, the role of inflammation in the process of atherosclerosis has become better defined. Multiple combinations of these CM risk factors in populations are termed clustering and, when present, increase the risk of CVD nonlinearly. As CVD is the leading cause of death among people with spinal cord injury (SCI) surviving for longer than 30 years (46% of deaths) and among persons with SCI more than 60 years of age (35% of deaths), it is imperative that we understand both population-specific CM risks and risk clustering, as well as the role played by risk surrogates in predicting population-specific CVD. The primary aim of this study is to describe the prevalence of atherosclerotic CVD using coronary calcium scoring, coronary angiography, and carotid intima media thickness (CIMT) in people with SCI. We will then assess the associations between CM risk clustering and CVD.

cardiovascular disease, cardiovascular imaging, spinal cord injury
Gorgey AS, Dudley GA. Skeletal muscle atrophy and increased intramuscular fat after incomplete spinal cord injury. Spinal Cord. 2007;45(4):304-309.
,
Skeletal muscle atrophy and increased intramuscular fat after incomplete spinal cord injury
,
Spinal Cord.
, vol.
45
(pg.
304
-
309
)
Gupta N, White KT, Sandford PR. Body mass index in spinal cord injury – a retrospective study. Spinal Cord. 2006;44:92-94.
,
Body mass index in spinal cord injury – a retrospective study
,
Spinal Cord.
, vol.
44
(pg.
92
-
94
)
Gater DR Jr. Obesity after spinal cord injury. Phys Med Rehabil Clin N Am. 2007; 18(2):333-351.
,
Obesity after spinal cord injury
,
Phys Med Rehabil Clin N Am.
, vol.
18
(pg.
333
-
351
)
Groah S, Nash M, Ward E, et al. Cardiometabolic risk in community dwelling persons with chronic spinal cord injury. JCRP. In press.
,
Cardiometabolic risk in community dwelling persons with chronic spinal cord injury
,
JCRP. In press.
Maki KC, Briones ER, Langbein WE, Inman-Felton A, Nemchausky B, Welch M, Burton J. Associations between serum lipids and indicators of adiposity in men with spinal cord injury. Paraplegia. 1995;33(2):102-109.
,
Associations between serum lipids and indicators of adiposity in men with spinal cord injury
,
Paraplegia.
, vol.
33
(pg.
102
-
109
)
Zlotolow SP, Levy E, Bauman WA. The serum lipoprotein profile in veterans with paraplegia: the relationship to nutritional factors and body mass index. J Am Paraplegia Soc. 1992;15:158-162.
,
The serum lipoprotein profile in veterans with paraplegia: the relationship to nutritional factors and body mass index
,
J Am Paraplegia Soc.
, vol.
15
(pg.
158
-
162
)
Bauman WA, Spungen AM, Zhong YG, Rothstein JL, Petry C, Gordon SK. Depressed serum high density lipoprotein cholesterol levels in veterans with spinal cord injury. Paraplegia. 1992;30:697-703.
,
Depressed serum high density lipoprotein cholesterol levels in veterans with spinal cord injury
,
Paraplegia.
, vol.
30
(pg.
697
-
703
)
Bauman WA, Spungen AM. Metabolic changes in persons after spinal cord injury. Phys Med Rehabil Clin N Am. 2000;11(1):109-140.
,
Metabolic changes in persons after spinal cord injury
,
Phys Med Rehabil Clin N Am.
, vol.
11
(pg.
109
-
140
)
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(3):134-138.
,
Risk factors for coronary heart disease in patients with spinal cord injury in Turkey
,
Spinal Cord.
, vol.
39
(pg.
134
-
138
)
Castelli WP, Anderson K, Wilson PW, Levy D. Lipids and risk of coronary heart disease: the Framingham Study. Ann Epidemiol. 1992;2:23-28.
,
Lipids and risk of coronary heart disease: the Framingham Study
,
Ann Epidemiol.
, vol.
2
(pg.
23
-
28
)
Groah SL, Nash MS, Ljungberg I, et al. Nutrient intake and body habitus after spinal cord injury: an analysis by sex and level of injury. J Spinal Cord Med. 2009;32(1):25-33.
,
Nutrient intake and body habitus after spinal cord injury: an analysis by sex and level of injury
,
J Spinal Cord Med.
, vol.
32
(pg.
25
-
33
)
de Koning L, Merchant AT, Pogue J, Anand SS. Waist circumference and waist-to-hip ratio as predictors of cardiovascular events: meta-regression analysis and prospective studies. Eur Heart J. 2007; 28(7):850-856.
,
Waist circumference and waist-to-hip ratio as predictors of cardiovascular events: meta-regression analysis and prospective studies
,
Eur Heart J.
, vol.
28
(pg.
850
-
856
)
Haffner SM, Despres J-P, Balkau B, et al. Waist circumference and body mass index are both independently associated with cardiovascular disease: The International Day for the Evaluation of Abdominal Obesity (IDEA) survey. J Am Coll Cardiol. 2006;47(4 suppl A):358A. Abstract 842-6.
,
Waist circumference and body mass index are both independently associated with cardiovascular disease: The International Day for the Evaluation of Abdominal Obesity (IDEA) survey
,
J Am Coll Cardiol.
, vol.
47
Despres JP, Lemieux I, Bergeron J, et al. Abdominal obesity and the metabolic syndrome: contribution to global cardiometabolic risk. Arterioscler Thromb Vasc Biol. 2008;28:1039-1049.
,
Abdominal obesity and the metabolic syndrome: contribution to global cardiometabolic risk
,
Arterioscler Thromb Vasc Biol.
, vol.
28
(pg.
1039
-
1049
)
Valentine RJ, Vieira VJ, Woods JA, Evans EM. Stronger relationship between central adiposity and C-reactive protein in older women than men. Menopause. 2009;16(1):84-89.
,
Stronger relationship between central adiposity and C-reactive protein in older women than men
,
Menopause.
, vol.
16
(pg.
84
-
89
)
Brooks GC, Blaha MJ, Blumenthal RS. Relation of C-reactive protein to abdominal adiposity. Am J Cardiol. 2010;106:56-61.
,
Relation of C-reactive protein to abdominal adiposity
,
Am J Cardiol.
, vol.
106
(pg.
56
-
61
)
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(9):513-518.
,
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.
, vol.
43
(pg.
513
-
518
)
Ridker PM, Cushman M, Stampfer MJ, Tracu RP, Hennekens CH. Plasma concentration of C-rective protein and risk of developing peripheral vascular disease. Circulation. 1998;97:425-428.
,
Plasma concentration of C-rective protein and risk of developing peripheral vascular disease
,
Circulation.
, vol.
97
(pg.
425
-
428
)
Nash MS, Mendez AJ. Nonfasting lipemia and inflammation as cardiovascular disease risks after SCI. Top Spinal Cord Inj Rehabil. 2009;14(3):15-31.
,
Nonfasting lipemia and inflammation as cardiovascular disease risks after SCI
,
Top Spinal Cord Inj Rehabil.
, vol.
14
(pg.
15
-
31
)
Nash MS, Gintel SL, Mendez AJ, Ham LF, Lewis JE, Groah SL. Elevated CRP and vascular disease after SCI: inflammatory epiphenomenon or pathologic agent? J Spinal Cord Med 2006;29(3):252.
,
Elevated CRP and vascular disease after SCI: inflammatory epiphenomenon or pathologic agent?
,
J Spinal Cord Med
, vol.
29
pg.
252
Biasucci LM. CDC/AHA Workshop on Markers of Inflammation and Cardiovascular Disease: Application to Clinical and Public Health Practice: clinical use of inflammatory markers in patients with cardiovascular diseases: a background paper. Circulation. 2004; 110(25): e560-567.
,
CDC/AHA Workshop on Markers of Inflammation and Cardiovascular Disease: Application to Clinical and Public Health Practice: clinical use of inflammatory markers in patients with cardiovascular diseases: a background paper
,
Circulation.
, vol.
110
(pg.
e560
-
567
)
Ridker PM, Hennekens CH, Buring JE, Rifai N. C-reactive protein and other markers of inflammation in the prediction of cardiovascular disease in women. N Engl J Med. 200;342:836-843.
,
C-reactive protein and other markers of inflammation in the prediction of cardiovascular disease in women
,
N Engl J Med.
, vol.
342
(pg.
836
-
843
)
Feng D, Tracy RP, Lipinska I, et al. Effect of short-term aspirin use on C-reactive protein. J Thromb Thrombolysis. 2000;9:37-41.
,
Effect of short-term aspirin use on C-reactive protein
,
J Thromb Thrombolysis.
, vol.
9
(pg.
37
-
41
)
Huang C, et al. Association of C-reactive protein and insulin resistance in patients with chronic spinal cord injury. J Rehabil Med. 2008;40:819-822.
,
Association of C-reactive protein and insulin resistance in patients with chronic spinal cord injury
,
J Rehabil Med.
, vol.
40
(pg.
819
-
822
)
Bauman WA, Spungen AM. Disorders of carbohydrate and lipid metabolism in veterans with paraplegia or quadriplegia: a model of premature aging. Metabolism. 1994;43:749-756.
,
Disorders of carbohydrate and lipid metabolism in veterans with paraplegia or quadriplegia: a model of premature aging
,
Metabolism.
, vol.
43
(pg.
749
-
756
)
Groah SL, Nash MS, Ljungberg I, et al. Nutrient intake and body habitus after spinal cord injury: an analysis by sex and level of injury. J Spinal Cord Med. 2009;32(1):25-33.
,
Nutrient intake and body habitus after spinal cord injury: an analysis by sex and level of injury
,
J Spinal Cord Med.
, vol.
32
(pg.
25
-
33
)
Nash MS, Gintel SL, Mendez AJ, et al. Elevated CRP and vascular disease after SCI: inflammatory epiphenomenon or pathologic agent? J Spinal Cord Med. 2006; 29(3):252.
,
Elevated CRP and vascular disease after SCI: inflammatory epiphenomenon or pathologic agent?
,
J Spinal Cord Med.
, vol.
29
pg.
252
Nash MS, Mendez AJ. A guideline-driven assessment of need for cardiovascular disease risk intervention in persons with chronic paraplegia. Arch Phys Med Rehbil. 2007;88:751-757.
,
A guideline-driven assessment of need for cardiovascular disease risk intervention in persons with chronic paraplegia
,
Arch Phys Med Rehbil.
, vol.
88
(pg.
751
-
757
)
Groah SL, Nash MS, Ward EA, et al. Cardiometabolic risk clustering in spinal cord injury: results from an exploratory factor analysis. Submitted for publication.
,
Cardiometabolic risk clustering in spinal cord injury: results from an exploratory factor analysis. Submitted for publication
,
JCRP. In press.
Groah SL, Spungen MS, Bauman WA. Cardiovascular disease in individuals with spinal cord injury: toward best practice. Top Spinal Cord Inj Rehabil. 2009;15(3):84-98.
,
Cardiovascular disease in individuals with spinal cord injury: toward best practice
,
Top Spinal Cord Inj Rehabil.
, vol.
15
(pg.
84
-
98
)
Wilt TJ, Carlson FK, Goldish GD, et al. Carbohydrate & lipid disorders & relevant considerations in persons with spinal cord injury. Evidence Report/Technology Assessment No. 163. Rockville, MD: Agency for Healthcare Research and Quality; January 2008. AHRQ Publication No. 08-E0005.
,
Carbohydrate & lipid disorders & relevant considerations in persons with spinal cord injury. Evidence Report/Technology Assessment No. 163.
Hodis HN, Mack WJ, LaBree L, et al. The role of carotid arterial intimamedia thickness in predicting clinical coronary events. Ann Intern Med. 1998;128:262-269.
,
The role of carotid arterial intimamedia thickness in predicting clinical coronary events
,
Ann Intern Med.
, vol.
128
(pg.
262
-
269
)
Bots ML, Hoes AW, Koudstaal PJ, Hofman A, Grobbee DE. Common carotid intimamedia thickness and risk of stroke and myocardial infarction: the Rotterdam Study. Circulation. 1997;96:1432-1437.
,
Common carotid intimamedia thickness and risk of stroke and myocardial infarction: the Rotterdam Study
,
Circulation.
, vol.
96
(pg.
1432
-
1437
)
Mack WJ, LaBree L, Liu C, Selzer RH, Hodis HN. Correlations between measures of atherosclerosis change using carotid ultrasonography and coronary angiography. Atherosclerosis. 2000;150:371-379.
,
Correlations between measures of atherosclerosis change using carotid ultrasonography and coronary angiography
,
Atherosclerosis.
, vol.
150
(pg.
371
-
379
)
Shinozaki K, Hattori Y, Suzuki M, et al. Insulin resistance as an independent risk factor for carotid artery wall intima media thickening in vasospastic angina. Arterioscler Thromb Vasc Biol. 1997;17:3302-3310.
,
Insulin resistance as an independent risk factor for carotid artery wall intima media thickening in vasospastic angina
,
Arterioscler Thromb Vasc Biol.
, vol.
17
(pg.
3302
-
3310
)
Matos-Souza JR, Pithon KR, Ozahata ≯TM, Cliquet A Jr, Nadruz W Jr. Carotid intima media-thickness is increased in patients with spinal cord injury independent of tradition cardiovascular risk factors. Atherosclerosis. 2009;202(1):29-31.
,
Carotid intima media-thickness is increased in patients with spinal cord injury independent of tradition cardiovascular risk factors
,
Atherosclerosis.
, vol.
202
(pg.
29
-
31
)
Stein JH, Korcarz CE, Hurst RT, et al. Use of cartoid ultrasound to identify subclinical vascular disease and evaluate cardiovascular disease risk: a consensus statement from the American Society of Echocardiography Carotid Intima – Media Thickness Task Force endorsed by the Society for Vascular Medicine. J Am Soc Echo. 2008;2:93-111.
,
Use of cartoid ultrasound to identify subclinical vascular disease and evaluate cardiovascular disease risk: a consensus statement from the American Society of Echocardiography Carotid Intima – Media Thickness Task Force endorsed by the Society for Vascular Medicine.
,
J Am Soc Echo.
, vol.
2
(pg.
93
-
111
)
Bild DE, Bluemke DA, Burke GL, et al. Multi-ethnic study of atherosclerosis: objectives and design. Am J Epidemiol. 2002;156(9):871-881.
,
Multi-ethnic study of atherosclerosis: objectives and design
,
Am J Epidemiol.
, vol.
156
(pg.
871
-
881
)
Folsom AR, Kronmal RA, Detrano RC, et al. Coronary artery calcification compared with carotid intimamedia thickness in the prediction of cardiovascular disease incidence: the Multi-Ethnic Study of Atherosclerosis (MESA). Arch Intern Med. 2008;168:1333-1339.
,
Coronary artery calcification compared with carotid intimamedia thickness in the prediction of cardiovascular disease incidence: the Multi-Ethnic Study of Atherosclerosis (MESA)
,
Arch Intern Med.
, vol.
168
(pg.
1333
-
1339
)
Budoff MJ. Prognostic value of coronary artery calcification. Vasc Dis Prevent. 2005; 2:2-10.
,
Prognostic value of coronary artery calcification
,
Vasc Dis Prevent.
, vol.
2
(pg.
2
-
10
)
Rumberger JA, Simons DB, Fitzpatrick LA, Sheedy PF, Schwartz RS. Coronary artery calcium area by electron beam computed tomography and coronary atherosclerotic plaque area: a histopathologic correlative study. Circulation. 1995;92: 2157-2162.
,
Coronary artery calcium area by electron beam computed tomography and coronary atherosclerotic plaque area: a histopathologic correlative study
,
Circulation.
, vol.
92
(pg.
2157
-
2162
)
Orakzai SH, Orakzai RH, Ahmadi N, 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.
,
Measurement of coronary artery calcification by electron beam computerized tomography in persons with chronic spinal cord injury: evidence for increased atherosclerotic burden
,
Spinal Cord.
, vol.
45
(pg.
775
-
779
)
Rumberger JA, Simons DB, Fitzpatrick LA, Sheedy PF, Schwartz RS. Coronary artery calcium area by electron beam computed tomography and coronary atherosclerotic plaque area. A histopathological correlative study. Circulation. 1995;92:2157-2162.
,
Coronary artery calcium area by electron beam computed tomography and coronary atherosclerotic plaque area. A histopathological correlative study
,
Circulation.
, vol.
92
(pg.
2157
-
2162
)
Stary HC, Chandler AB, Dinsmore RE, et al. A definition of advanced types of atherosclerotic lesions and a histological classification of atherosclerosis. A report from the Committee on Vascular Lesions of the Council on Arteriosclerosis. American Heart Association. Circulation. 1995:92:1355-1374.
,
A definition of advanced types of atherosclerotic lesions and a histological classification of atherosclerosis. A report from the Committee on Vascular Lesions of the Council on Arteriosclerosis. American Heart Association
,
Circulation.
, vol.
92
(pg.
1355
-
1374
)
Bamberg F, Dannemann N, Shapiro MD, et al. Association between cardiovascular risk profiles and the presence and extent of different types of coronary atherosclerotic plaque as detected by multidetector computed tomography. Arterioscler Thromb Vasc Biol. 2008;28:568-574.
,
Association between cardiovascular risk profiles and the presence and extent of different types of coronary atherosclerotic plaque as detected by multidetector computed tomography
,
Arterioscler Thromb Vasc Biol.
, vol.
28
(pg.
568
-
574
)
Hausleiter J, Meyer T, Hadamitzkty M, Kastrati A, Martinoff S, Schomig A. Prevalence of noncalcified coronary plaques by 64-slice computed tomography in patients with an intermediate risk for significant coronary artery disease. J Am Coll Cardiol. 2006;48: 312-318.
,
Prevalence of noncalcified coronary plaques by 64-slice computed tomography in patients with an intermediate risk for significant coronary artery disease
,
J Am Coll Cardiol.
, vol.
48
(pg.
312
-
318
)
Motoyama S, Kondo T, Sarai M, et al. Multislice computed tomographic characteristics of coronary lesions in acute coronary syndromes. J Am Coll Cardiol. 2007;50:319-326.
,
Multislice computed tomographic characteristics of coronary lesions in acute coronary syndromes
,
J Am Coll Cardiol.
, vol.
50
(pg.
319
-
326
)
National High Blood Pressure Education Program Coordinating Committee. Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypotension. 2003;42:1206-1252.
,
National High Blood Pressure Education Program Coordinating Committee. Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure
,
Hypotension.
, vol.
42
(pg.
1206
-
1252
)
Spungen AM, Adkins RH, Stewart CA, et al. Factors influencing body composition in persons with spinal cord injury: a cross-sectional study. J Appl Physiol. 2003;95:2398-2407.
,
Factors influencing body composition in persons with spinal cord injury: a cross-sectional study
,
J Appl Physiol.
, vol.
95
(pg.
2398
-
2407
)
Jones LM, Goulding A, Gerrard DF. DEXA: a practical and accurate tool to demonstrate total and regional bone loss, lean tissue loss and fat mass gain in paraplegia. Spinal Cord. 1998;36:637-640.
,
DEXA: a practical and accurate tool to demonstrate total and regional bone loss, lean tissue loss and fat mass gain in paraplegia
,
Spinal Cord.
, vol.
36
(pg.
637
-
640
)
Spungen AM, Bauman WA, Wang J, Pierson RN. Measurement of body fat in individuals with tetraplegia: a comparison of eight clinical methods. Paraplegia. 1995;33:402-408.
,
Measurement of body fat in individuals with tetraplegia: a comparison of eight clinical methods
,
Paraplegia.
, vol.
33
(pg.
402
-
408
)
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;18:499-502.
,
Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge
,
Clin Chem.
, vol.
18
(pg.
499
-
502
)
Nash MS, Mendez AJ. A guideline-driven assessment of need for cardiovascular disease risk intervention in persons with chronic paraplegia. Arch Phys Med Rehabil. 2007;88: 751-757.
,
A guideline-driven assessment of need for cardiovascular disease risk intervention in persons with chronic paraplegia
,
Arch Phys Med Rehabil.
, vol.
88
(pg.
751
-
757
)
Woolf SH. The meaning of translational research and why it matters. JAMA. 2008; 299:211-213.
,
The meaning of translational research and why it matters
,
JAMA.
, vol.
299
(pg.
211
-
213
)
Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults. Executive Summary of the Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA. 2001;285:2486-2497.
,
Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults. Executive Summary of the Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III)
,
JAMA.
, vol.
285
(pg.
2486
-
2497
)
This content is only available as a PDF.