Background: Chronic spinal cord injury (SCI) is associated with an increase in risk factors for cardiovascular disease (CVD). In the general population, atherosclerosis in women occurs later than in men and usually presents differently. Associations between risk factors and incidence of CVD have not been studied in women with SCI. Objective: To determine which risk factors for CVD are associated with increased carotid intima-media thickness (CIMT), a common indicator of atherosclerosis, in women with SCI. Methods: One hundred and twenty-two females older than 18 years with traumatic SCI at least 2 years prior to entering the study were evaluated. Participants were asymptomatic and without evidence of CVD. Exclusion criteria were acute illness, overt heart disease, diabetes, and treatment with cardiac drugs, lipid-lowering medication, or antidiabetic agents. Measures for all participants were age, race, smoking status, level and completeness of injury, duration of injury, body mass index, serum lipids, fasting glucose, hemoglobin A1c, and ultrasonographic measurements of CIMT. Hierarchical multiple linear regression was conducted to predict CIMT from demographic and physiologic variables. Results: Several variables were significantly correlated with CIMT during univariate analyses, including glucose, hemoglobin A1c, age, and race/ethnicity; but only age was significant in the hierarchical regression analysis. Conclusion: Our data indicate the importance of CVD in women with SCI.
Bauman WA, Kahn NN, Grimm Spungen AM. Risk factors for atherogenesis and cardiovascular autonomic function in persons with spinal cord injury. Spinal Cord. 1999;37(9):601–616.
,
Risk factors for atherogenesis and cardiovascular autonomic function in persons with spinal cord injury
, Spinal Cord.
, vol. 37
(pg. 601
-616
) Bauman WA, Adkins RH, Spungen AM, Kemp BJ, Waters RL. The effect of residual neurological deficit on serum lipoproteins in individuals with chronic spinal cord injury. Spinal Cord. 1998;36(1):13–17.
,
The effect of residual neurological deficit on serum lipoproteins in individuals with chronic spinal cord injury
, Spinal Cord.
, vol. 36
(pg. 13
-17
) Bauman WA, Spungen AM, Zhong YG, et al. Depressed serum high density lipoprotein cholesterol levels in veterans with spinal cord injury. Paraplegia. 1992;30(10):697–703.
,
Depressed serum high density lipoprotein cholesterol levels in veterans with spinal cord injury
, Paraplegia.
, vol. 30
(pg. 697
-703
) Krum H, Howes LG, Brown DJ, et al. Risk factors for cardiovascular disease in chronic spinal cord injury patients. Paraplegia. 1992;30(6):381–388.
,
Risk factors for cardiovascular disease in chronic spinal cord injury patients
, Paraplegia.
, vol. 30
(pg. 381
-388
) Bauman WA, Spungen AM. Disorders of carbohydrate and lipid metabolism in veterans with paraplegia or quadriplegia: A model of premature aging. Metabolism. 1994;43(6):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
) LaVela SL, Evans CT, Prohaska TR, et al. Males aging with a spinal cord injury: Prevalence of cardiovascular and metabolic conditions. Arch Phys Med Rehabil. 2012;93(1):90–95.
,
Males aging with a spinal cord injury: Prevalence of cardiovascular and metabolic conditions
, Arch Phys Med Rehabil.
, vol. 93
(pg. 90
-95
) Levi R, Hultling C, Seiger A. The Stockholm Spinal Cord Injury Study. 3. Health-related issues of the Swedish annual level-of-living survey in SCI subjects and controls. Paraplegia. 1995;33(12):726–730.
,
The Stockholm Spinal Cord Injury Study. 3. Health-related issues of the Swedish annual level-of-living survey in SCI subjects and controls
, Paraplegia.
, vol. 33
(pg. 726
-730
) Imai K, Kadowaki T, Aizawa Y, Fukutomi K. Problems in the health management of persons with spinal cord injury. J Clin Epidemiol. 1996;49(5):505–510.
,
Problems in the health management of persons with spinal cord injury
, J Clin Epidemiol.
, vol. 49
(pg. 505
-510
) Rish BL, 21 Dilustro JF, Salazar AM, Schwab KA, Brown HR. Spinal cord injury: A 25-year morbidity and mortality study. Mil Med. 1997;162(2):141–148.
,
Spinal cord injury: A 25-year morbidity and mortality study
, Mil Med.
, vol. 162
(pg. 141
-148
) 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(6):310–317.
,
The relationship between neurological level of injury and symptomatic cardiovascular disease risk in the aging spinal injured
, Spinal Cord.
, vol. 39
(pg. 310
-317
) Cardenas DD, Hoffman JM, Kirshblum S, McKinley W. Etiology and incidence of rehospitalization after traumatic spinal cord injury: A multicenter analysis. Arch Phys Med Rehabil. 2004;85(11):1757–1763.
,
Etiology and incidence of rehospitalization after traumatic spinal cord injury: A multicenter analysis
, Arch Phys Med Rehabil.
, vol. 85
(pg. 1757
-1763
) 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(2):142–152.
,
Cardiovascular disease in spinal cord injury: An overview of prevalence, risk, evaluation, and management
, Am J Phys Med Rehabil.
, vol. 86
(pg. 142
-152
) Mitsui T, Nakamura T, Ito T, et al. Exercise significantly increases plasma adrenaline and oxidized low- density lipoprotein in normal healthy subjects but not in persons with spinal cord injury. Arch Phys Med Rehabil. 2012;93(4):725–727.
,
Exercise significantly increases plasma adrenaline and oxidized low- density lipoprotein in normal healthy subjects but not in persons with spinal cord injury
, Arch Phys Med Rehabil.
, vol. 93
(pg. 725
-727
) Bauman WA, Raza M, Spungen AM, Machac J. Cardiac stress testing with thallium-201 imaging reveals silent ischemia in individuals with paraplegia. Arch Phys Med Rehabil. 1994;75(9):946–950.
,
Cardiac stress testing with thallium-201 imaging reveals silent ischemia in individuals with paraplegia
, Arch Phys Med Rehabil.
, vol. 75
(pg. 946
-950
) Szlachcic Y, Adkins RH, Khawaja H, Hodis H. Metabolic syndrome adversely affects blood vessels in women with SCI [abstract]. J Spinal Cord Med. 2005;28(2):137.
,
Metabolic syndrome adversely affects blood vessels in women with SCI [abstract]
, J Spinal Cord Med.
, vol. 28
Lee C-S, Lu Y-H, Lee S-T, Lin C-C, Ding H-J. Evaluating the prevalence of silent coronary artery disease in asymptomatic patients with spinal cord injury. Int Heart J. 2006;47(3):325–330.
,
Evaluating the prevalence of silent coronary artery disease in asymptomatic patients with spinal cord injury
, Int Heart J.
, vol. 47
(pg. 325
-330
) Szlachcic Y, Carrothers L, Adkins RH, Waters R. Clinical significance of abnormal electrocardiographic findings in individuals aging with spinal injury and abnormal lipid profiles. J Spinal Cord Med. 2007;30(5):473–476.
,
Clinical significance of abnormal electrocardiographic findings in individuals aging with spinal injury and abnormal lipid profiles
, J Spinal Cord Med.
, vol. 30
(pg. 473
-476
) Orakzai SH, Orakzai RH, Ahmadi N, et al. Measurement of coronar y arter y calcification by electron beam computerized tomography in persons with chronic spinal cord injury: Evidence for increased atherosclerotic burden. Spinal Cord. 2007;45(12):775–779.
,
Measurement of coronar y arter y 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
) DeFronzo RA. Insulin resistance: A multifaceted syndrome responsible for NIDDM, obesity, hypertension, dyslipidaemia and atherosclerosis. Neth J Med. 1997;50(5):191–197.
,
Insulin resistance: A multifaceted syndrome responsible for NIDDM, obesity, hypertension, dyslipidaemia and atherosclerosis
, Neth J Med.
, vol. 50
(pg. 191
-197
) Grundy SM, Brewer HB Jr, Cleeman JI, Smith SC, Jr., Lenfant C. Definition of metabolic syndrome: Report of the National Heart, Lung, and Blood Institute/American Heart Association conference on scientific issues related to definition. Circulation. 2004;109(3):433–438.
,
Definition of metabolic syndrome: Report of the National Heart, Lung, and Blood Institute/American Heart Association conference on scientific issues related to definition
, Circulation.
, vol. 109
(pg. 433
-438
) Sipski ML, Jackson AB, Gomez-Marin O, Estores I, Stein A. Effects of gender on neurologic and functional recovery after spinal cord injury. Arch Phys Med Rehabil. 2004;85(11):1826–1836.
,
Effects of gender on neurologic and functional recovery after spinal cord injury
, Arch Phys Med Rehabil.
, vol. 85
(pg. 1826
-1836
) Melloni C, Berger JS, Wang TY, et al. Representation of women in randomized clinical trials of cardiovascular disease prevention. Circ Cardiovasc Qual Outcomes. 2010;3(2):135–142.
,
Representation of women in randomized clinical trials of cardiovascular disease prevention
, Circ Cardiovasc Qual Outcomes.
, vol. 3
(pg. 135
-142
) Lindquist R, Witt DR, Boucher JL. Preventing cardiovascular disease in women: How can we do better? Curr Opin Cardiol. 2012;27(5):542–549.
,
Preventing cardiovascular disease in women: How can we do better?
, Curr Opin Cardiol.
, vol. 27
(pg. 542
-549
) Stranges S, Guallar E. Cardiovascular disease prevention in women: A rapidly evolving scenario. Nutr Metab Cardiovasc Dis. 2012;22(12):1013–1018.
,
Cardiovascular disease prevention in women: A rapidly evolving scenario
, Nutr Metab Cardiovasc Dis.
, vol. 22
(pg. 1013
-1018
) Bauman WA, Adkins RH, Spungen AM, et al. Is immobilization associated with an abnormal lipoprotein profile? Observations from a diverse cohort. Spinal Cord. 1999;37(7):485–493.
,
Is immobilization associated with an abnormal lipoprotein profile? Observations from a diverse cohort
, Spinal Cord.
, vol. 37
(pg. 485
-493
) Storch MJ, Konig D, Bultermann D, et al. Lipid profile in spinal cord-injured women with different injury levels. Prev Med. 2005;40(3):321–325.
,
Lipid profile in spinal cord-injured women with different injury levels.
, Prev Med.
, vol. 40
(pg. 321
-325
) Leuzzi C, Sangiorgi GM, Modena MG. Gender-specific aspects in the clinical presentation of cardiovascular disease. Fundam Clin Pharmacol. 2010;24(6):711–717.
,
Gender-specific aspects in the clinical presentation of cardiovascular disease
, Fundam Clin Pharmacol.
, vol. 24
(pg. 711
-717
) Hodis HN, Mack WJ, LaBree L, et al. The role of carotid arterial intima-media thickness in predicting clinical coronary events. Ann Intern Med. 1998;128(4):262–269.
,
The role of carotid arterial intima-media thickness in predicting clinical coronary events
, Ann Intern Med.
, vol. 128
(pg. 262
-269
) Salonen R, Salonen JT. Determinants of carotid intima–media thickness: A population-based ultrasonography study in eastern Finnish men. J Intern Med. 1991;229(3):225–231.
,
Determinants of carotid intima–media thickness: A population-based ultrasonography study in eastern Finnish men
, J Intern Med.
, vol. 229
(pg. 225
-231
) Bonithon-Kopp C, Scarabin PY, Taquet A, et al. Risk factors for early carotid atherosclerosis in middle-aged French women. Arterioscler Thromb. 1991;11(4):966–972.
,
Risk factors for early carotid atherosclerosis in middle-aged French women
, Arterioscler Thromb.
, vol. 11
(pg. 966
-972
) Crouse JR, Toole JF, McKinney WM, et al. Risk factors for extracranial carotid artery atherosclerosis. Stroke. 1987;18(6):990–996.
,
Risk factors for extracranial carotid artery atherosclerosis
, Stroke.
, vol. 18
(pg. 990
-996
) Craven TE, Ryu JE, Espeland MA, et al. Evaluation of the associations between carotid artery atherosclerosis and coronary artery stenosis. A case-control study. Circulation. 1990;82(4):1230–1242.
,
Evaluation of the associations between carotid artery atherosclerosis and coronary artery stenosis. A case-control study
, Circulation.
, vol. 82
(pg. 1230
-1242
) Wofford JL, Kahl FR, Howard GR, et al. Relation of extent of extracranial carotid artery atherosclerosis as measured by B-mode ultrasound to the extent of coronary atherosclerosis. Arterioscler Thromb. 1991;11(6):1786–1794.
,
Relation of extent of extracranial carotid artery atherosclerosis as measured by B-mode ultrasound to the extent of coronary atherosclerosis
, Arterioscler Thromb.
, vol. 11
(pg. 1786
-1794
) Hodis HN, Mack WJ. Carotid artery intima-media thickness and risk of cardiovascular events. Curr Pract Med. 1999;2:171–174.
,
Carotid artery intima-media thickness and risk of cardiovascular events
, Curr Pract Med.
, vol. 2
(pg. 171
-174
) Chambless LE, Heiss G, Folsom AR, et al. Association of coronary heart disease incidence with carotid arterial wall thickness and major risk factors: The Atherosclerosis Risk in Communities (ARIC) Study, 1987–1993. Am J Epidemiol. 1997;146(6):483–494.
,
Association of coronary heart disease incidence with carotid arterial wall thickness and major risk factors: The Atherosclerosis Risk in Communities (ARIC) Study, 1987–1993
, Am J Epidemiol.
, vol. 146
(pg. 483
-494
) Salonen JT, Salonen R. Ultrasound B-mode imaging in observational studies of atherosclerotic progression. Circulation. 1993;87(3 Suppl):56–65.
,
Ultrasound B-mode imaging in observational studies of atherosclerotic progression
, Circulation.
, vol. 87
(pg. 56
-65
) Bots ML, Hoes AW, Koudstaal PJ, Hofman A, Grobbee DE. Common carotid intima-media thickness and risk of stroke and myocardial infarction: The Rotterdam Study. Circulation. 1997;96(5):1432–1437.
,
Common carotid intima-media thickness and risk of stroke and myocardial infarction: The Rotterdam Study
, Circulation.
, vol. 96
(pg. 1432
-1437
) O’Leary DH, Polak JF, Kronmal RA, et al. Carotid-artery intima and media thickness as a risk factor for myocardial infarction and stroke in older adults. Cardiovascular Health Study Collaborative Research Group. N Engl J Med. 1999;340(1):14–22.
,
Carotid-artery intima and media thickness as a risk factor for myocardial infarction and stroke in older adults. Cardiovascular Health Study Collaborative Research Group
, N Engl J Med.
, vol. 340
(pg. 14
-22
) Tsivgoulis G, Vemmos K, Papamichael C, et al. Common carotid artery intima-media thickness and the risk of stroke recurrence. Stroke. 2006;37(7):1913–1916.
,
Common carotid artery intima-media thickness and the risk of stroke recurrence
, Stroke.
, vol. 37
(pg. 1913
-1916
) Lorenz MW, von Kegler S, Steinmetz H, Markus HS, Sitzer M. Carotid intima-media thickening indicates a higher vascular risk across a wide age range: Prospective data from the Carotid Atherosclerosis Progression Study (CAPS). Stroke. 2006;37(1):87–92.
,
Carotid intima-media thickening indicates a higher vascular risk across a wide age range: Prospective data from the Carotid Atherosclerosis Progression Study (CAPS)
, Stroke.
, vol. 37
(pg. 87
-92
) Kitamura A, Iso H, Imano H, et al. Carotid intima- media thickness and plaque characteristics as a risk factor for stroke in Japanese elderly men. Stroke. 2004; 35(12):2788–2794.
,
Carotid intima- media thickness and plaque characteristics as a risk factor for stroke in Japanese elderly men
, Stroke.
, vol. 35
(pg. 2788
-2794
) Iglesias del Sol A, Bots ML, Grobbee DE, Hofman A, Witteman JCM. Carotid intima-media thickness at different sites: Relation to incident myocardial infarction; The Rotterdam Study. Eur Heart J. 2002;23(12):934–940.
,
Carotid intima-media thickness at different sites: Relation to incident myocardial infarction; The Rotterdam Study
, Eur Heart J.
, vol. 23
(pg. 934
-940
) Rosvall M, Janzon L, Berglund G, Engström G, Hedblad B. Incident coronary events and case fatality in relation to common carotid intima-media thickness. J Intern Med. 2005;257(5):430–437.
,
Incident coronary events and case fatality in relation to common carotid intima-media thickness
, J Intern Med.
, vol. 257
(pg. 430
-437
) Murakami S, Otsuka K, Hotta N, et al. Common carotid intima-media thickness is predictive of all-cause and cardiovascular mortality in elderly community-dwelling people: Longitudinal Investigation for the Longevity and Aging in Hokkaido County (LILAC) study. Biomed Pharmacother. 2005;59(Suppl 1):49–53.
,
Common carotid intima-media thickness is predictive of all-cause and cardiovascular mortality in elderly community-dwelling people: Longitudinal Investigation for the Longevity and Aging in Hokkaido County (LILAC) study
, Biomed Pharmacother.
, vol. 59
(pg. 49
-53
) Belcaro G, Nicolaides AN, Laurora G, et al. Ultrasound morphology classification of the arterial wall and cardiovascular events in a 6-year follow-up study. Arterioscler Thromb Vasc Biol. 1996;16(7):851–856.
,
Ultrasound morphology classification of the arterial wall and cardiovascular events in a 6-year follow-up study
, Arterioscler Thromb Vasc Biol.
, vol. 16
(pg. 851
-856
) Kitagawa K, Hougaku H, Yamagami H, et al. Carotid intima-media thickness and risk of cardiovascular events in high-risk patients. Results of the Osaka Follow-Up Study for Carotid Atherosclerosis 2 (OSACA2 Study). Cerebrovasc Dis. 2007;24(1):35–42.
,
Carotid intima-media thickness and risk of cardiovascular events in high-risk patients. Results of the Osaka Follow-Up Study for Carotid Atherosclerosis 2 (OSACA2 Study)
, Cerebrovasc Dis.
, vol. 24
(pg. 35
-42
) Burke GL, Evans GW, Riley WA, et al. Arterial wall thickness is associated with prevalent cardiovascular disease in middle-aged adults. The Atherosclerosis Risk in Communities (ARIC) Study. Stroke. 1995; 26(3):386–391.
,
Arterial wall thickness is associated with prevalent cardiovascular disease in middle-aged adults. The Atherosclerosis Risk in Communities (ARIC) Study
, Stroke.
, vol. 26
(pg. 386
-391
) Matos-Souza JR, Pithon KR, Ozahata TM, et al. Carotid intima-media thickness is increased in patients with spinal cord injury independent of traditional cardiovascular risk factors. Atherosclerosis. 2009;202(1):29–31.
,
Carotid intima-media thickness is increased in patients with spinal cord injury independent of traditional cardiovascular risk factors
, Atherosclerosis.
, vol. 202
(pg. 29
-31
) Blankenhorn DH, Hodis HN. George Lyman Duff Memorial Lecture. Arterial imaging and atherosclerosis reversal. Arterioscler Thromb. 1994; 14(2):177–192.
,
George Lyman Duff Memorial Lecture. Arterial imaging and atherosclerosis reversal
, Arterioscler Thromb.
, vol. 14
(pg. 177
-192
) Selzer RH, Hodis HN, Kwong-Fu H, et al. Evaluation of computerized edge tracking for quantifying intima-media thickness of the common carotid artery from B-mode ultrasound images. Atherosclerosis. 1994;111(1):1–11.
,
Evaluation of computerized edge tracking for quantifying intima-media thickness of the common carotid artery from B-mode ultrasound images
, Atherosclerosis.
, vol. 111
(pg. 1
-11
) Selzer RH, Mack WJ, Lee PL, Kwong-Fu H, Hodis HN. Improved common carotid elasticity and intima-media thickness measurements from computer analysis of sequential ultrasound frames. Atherosclerosis. 2001;154(1):185–193.
,
Improved common carotid elasticity and intima-media thickness measurements from computer analysis of sequential ultrasound frames.
, Atherosclerosis.
, vol. 154
(pg. 185
-193
) de Groot S, Post MW, Snoek GJ, Schuitemaker M, van der Woude LH. Longitudinal association between lifestyle and coronary heart disease risk factors among individuals with spinal cord injury. Spinal Cord. 2013;51(4):314–318.
,
Longitudinal association between lifestyle and coronary heart disease risk factors among individuals with spinal cord injury
, Spinal Cord.
, vol. 51
(pg. 314
-318
) Beck LA, Lamb JL, Atkinson EJ, Wuermser LA, Amin S. Body composition of women and men with complete motor paraplegia. J Spinal Cord Med. 2013.
,
Body composition of women and men with complete motor paraplegia
, J Spinal Cord Med.
Krause JS, Carter RE. Risk of mortality after spinal cord injury: Relationship with social support, education, and income. Spinal Cord. 2009;47(8):592–596.
,
Risk of mortality after spinal cord injury: Relationship with social support, education, and income
, Spinal Cord.
, vol. 47
(pg. 592
-596
) Krause JS, Bozard JL. Natural course of life changes after spinal cord injury: A 35-year longitudinal study. Spinal Cord. 2012;50(3):227–231.
,
Natural course of life changes after spinal cord injury: A 35-year longitudinal study
, Spinal Cord.
, vol. 50
(pg. 227
-231
) Szlachcic Y, Adkins RH, Govindarajan S. Disparities in cardiometabolic risk, status, and change among ethnic minorities and women with SCI. Presented at The State of the Science of Prevention and Management of Secondary Health Conditions in People after Spinal Cord Injury pre-course at the 40th Annual Meeting of the American Spinal Injury Association; April 2013; Chicago, IL.
,
Disparities in cardiometabolic risk, status, and change among ethnic minorities and women with SCI.
Mosca L, Benjamin EJ, Berra K, et al. Effectiveness- based guidelines for the prevention of cardiovascular disease in women–2011 update: A Guideline from the American Heart Association. Circulation. 2011;123(11):1243–1262.
,
Effectiveness- based guidelines for the prevention of cardiovascular disease in women–2011 update: A Guideline from the American Heart Association
, Circulation.
, vol. 123
(pg. 1243
-1262
)
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