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BCIT Citations Collection

Cardiovascular disease and spinal cord injury
Over the last decade, there have been marked changes in the trends of morbidity and mortality among individuals with spinal cord injury (SCI). With advances in acute care and in the management of septicemia, renal failure, and pneumonia, cardiovascular complications are now a leading cause of death in those with SCI.1 Moreover, several risk factors for cardiovascular disease (CVD) are amplified in individuals with SCI compared with able-bodied individuals, including physical inactivity, dyslipidemia, blood pressure irregularities, chronic inflammation, and abnormal glycemic control.2โ€“22. While most of the literature with respect to CVD and SCI has shown a higher prevalence of risk factors for CVD,2โ€“22 relatively few studies have examined the prevalence of CVD itself and corresponding risk estimates.23โ€“26 None of these studies has provided direct comparisons of risk estimates for multiple CVD outcomes in the SCI population compared to a non-SCI population, with appropriate adjustment for confounding, in a large representative sample. It thus remains unknown whether there is excess risk of both heart disease and stroke (after adjustment for potential confounders) in individuals with SCI. The current study addresses this knowledge gap by utilizing the national Canadian Community Health Survey (CCHS), which is comprised of comprehensive, up-to-date, cross-sectional data. Our aim was to estimate the prevalence of heart disease and stroke outcomes in the SCI population, to compare their risk with a non-SCI population, and to investigate this relationship after controlling for confounders., Peer-reviewed article, Published. Received December 02, 2012 ; Accepted April 22, 2013.
Optimal scaling of weight and waist circumference to height for adiposity and cardiovascular disease risk in individuals with spinal cord injury
Study Design: Observational cross-sectional study. Objectives: Body mass index (BMI), measured as a ratio of weight (Wt) to the square of height (Wt/Ht(2)), waist circumference (WC) and waist-to-height ratio (WHtR) are common surrogate measures of adiposity. It is not known whether alternate scaling powers for height might improve the relationships between these measures and indices of obesity or cardiovascular disease (CVD) risk in individuals with spinal cord injury (SCI). We aimed to estimate the values of 'x' that render Wt/Ht(x) and WC/Ht(x) maximally correlated with dual energy x-ray absorptiometry (DEXA) total and abdominal body fat and Framingham Cardiovascular Risk Scores. Setting: Canadian public research institution. Methods: We studied 27 subjects with traumatic SCI. Height, Wt and body fat measurements were determined from DEXA whole-body scans. WC measurements were also obtained, and individual Framingham Risk Scores were calculated. For values of 'x' ranging from 0.0 to 4.0, in increments of 0.1, correlations between Wt/Ht(x) and WC/Ht(x) with total and abdominal body fat (kg and percentages) and Framingham Risk Scores were computed. Results: We found that BMI was a poor predictor of CVD risk, regardless of the scaling factor. Moreover, BMI was strongly correlated with measures of obesity, and modification of the scaling factor from the standard (Wt/Ht(2)) is not recommended. WC was strongly correlated with both CVD risk and obesity, and standard measures (WC and WHtR) are of equal predictive power. Conclusion: On the basis of our findings from this sample, alterations in scaling powers may not be necessary in individuals with SCI; however, these findings should be validated in a larger cohort., Peer-reviewed article, Published. Received 25 February 2014; revised 1 May 2014; accepted 1 August 2014; published online 30 September 2014.