medwireNews: People with a spinal cord injury (SCI) have a significantly increased risk for myocardial infarction (MI), heart failure (HF), and atrial fibrillation (AF) compared with the general population, indicates a study published in the Journal of the American College of Cardiology.
In the Korean cohort study, investigator Kyungdo Han (Soongsil University, Seoul) and colleagues analyzed health insurance data for 5083 adult SCI survivors, whose injury occurred between 2010 and 2018, and 19,320 controls matched for age and sex.
At a mean follow-up of 4.3 years, the risks for MI, HF, and AF were significantly higher for SCI survivors than controls, with hazard ratios (HR) of 2.41, 2.24, and 1.84, respectively. This was after adjusting for age, sex, socioeconomic status, smoking status, alcohol consumption, physical activity, and comorbidities.
The number of events per 1000 person–years in SCI survivors compared with controls were 7.3 versus 2.7 for MI, 18.8 versus 6.9 for HF, and 6.8 versus 3.2 for AF.
“Clinicians must be aware of the importance of cardiovascular disease in the SCI population, and interventions and targeted prevention strategies addressing modifiable risk factors for cardiovascular disease should be reinforced,” say Han and colleagues.
The risks were increased even further for those SCI survivors who had disability, particularly severe disability, graded as 1 to 3 out of a possible 6, where 1 is the severest injury, on the Korea National Disability Registration System within a year of injury. For these individuals, the adjusted HRs were 3.74 for MI, 3.96 for HF, and 3.32 for AF, compared with controls.
The level of injury also affected cardiovascular risk. Survivors with cervical or lumbar SCI had an increased risk for heart disease regardless of disability compared with matched controls, with the risks slightly higher in those with disability. For patients with cervical SCI, the significant HRs were 2.36 for MI, 2.99 for HF, and 2.40 for AF. For lumbar SCI, they were a respective 2.87, 2.35, and 2.47. Among thoracic SCI survivors, only those with disability had a significantly increased risk for MI and HF, of 5.62 and 3.31, respectively, but not for AF.
The mean age of the SCI survivors was 58.1 years at baseline and 74.8% were men. Han and colleagues note that, “[c]ompared with matched controls, SCI survivors were more likely to be heavy drinkers and former or current smokers and have higher fasting glucose levels, hypertension, [and] type 2 diabetes.”
However, in subgroup analyses stratifying for obesity and the presence of comorbidities, such as hypertension and diabetes, the risk for MI, HF, and AF remained increased among SCI survivors.
Christopher West and Jacquelyn Cragg, both from the University of British Columbia in Vancouver, Canada, highlight in a linked editorial on the study that this finding “suggests that there is something unique to SCI, outside of traditional risk factors, that increases risk for cardiovascular events.”
They point out that dysautonomia is an important SCI-related risk factor for cardiac events and cardiometabolic disease, and say the findings are a “call-to-arms” for clinicians to “begin studying the clinical efficacy of neuraxial therapies that could help restore autonomic balance.”
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