The relationship between neurological level of injury and symptomatic cardiovascular disease risk in the aging spinal injured

Study objectives: To describe the distribution of clinically apparent cardi ovascular disease (CVD) in people with long-term spinal cord injury (SCI) a ccording to neurologic level and severity of injury. Design: Historical prospective study. Setting: Two British Spinal Injuries Centers. Participants: Five hundred and forty-five individuals surviving at least 20 years with SCI were divided into three neurologic categories by level of i njury and Frankel/ASIA grade as follows: Tetra ABC, Para ABC, and All D. Main outcome measures: Cardiovascular disease outcomes defined by ICD/9 cod es 390-448 and obtained through medical record review. Cardiovascular disea se outcomes measured included All CVD, coronary heart disease (CHD), hypert ension, cerebrovascular disease, valvular disease, and dysrhythmia. Results: After age-adjustment, the rates of All CVD were 35.2, 29.9, and 21 .2 per 1000 SCI person-years in the Tetra ABC, Para ABC, and All D groups, respectively. Rates of All CVD increased with increasing age in all neurolo gic groups. Tetraplegic level of SCI conferred an excess 16% risk of All CV D (95% Confidence interval [CI], 0.93-1.46), a fivefold risk of cerebrovasc ular disease (relative risk [RR] 5.06; 95% CI, 1.21-21.15), and 70% less CH D (RR 0.30; 95% CI, 0.13-0.70) when compared with paraplegics. More complet e SCI was associated with an excess 44% All CVD risk (95% CI, 1.16-1.77). Conclusions: Risk of All CVD increased with increasing age, rostral level o f SCI, and severity of SCI. More rostral level of SCI was associated with c erebrovascular disease, dysrhythmia, and valvular disease. Conversely, ther e was an inverse relationship between level of SCI and CHD.