Patients with spinal cord injury (SCI) are at significantly higher risk for developing heart disease than non-SCI patients, especially when the SCI causes a severe disability, a new study finds. These data were reported by Jung Eun Yoo, MD, PhD, of Seoul National University Hospital, South Korea, and colleagues, in a manuscript published Monday online and in the Feb. 20 issue of the Journal of the American College of Cardiology. SCI is a complicated, life-altering event and comes with many physical, psychological and socioeconomic complications. The premature death rate remains high for those who experience SCI, and cardiovascular disease has recently been reported as the leading cause of death in SCI patients. Traditional cardiovascular risk factors, such as irregular blood pressure and physical inactivity, burden SCI survivors more than the average adult. Cardiovascular problems are a growing concern for this community. A total of 5,083 SCI survivors (mean age=58.1, 74.8% male) were included in this analysis after selection criteria and were drawn from the patient database created by the National Health Insurance Service in the Republic of Korea. Age- and sex-matched non-SCI controls were also included in the study (1:3 ratio; non-SCI n=19,320, mean age=57.8 years, 75.2% male). Myocardial infarction (MI), heart failure (HF) and atrial fibrillation were the included study outcomes. The patients were followed from the date of SCI diagnosis (the index date, between 2010 and 2018; corresponding date for the controls matched to SCI patients) to 2019. Compared with the control group, survivors of SCI were at greater risk for MI (adjusted hazard ratio [aHR]=2.41, 95% confidence interval [CI]=1.93-3.00), HF (aHR=2.24, 95% CI=1.95-2.56) and AF (aHR=1.84; 95% CI=1.49-2.28). ;; Of these patients, those who were added to the National Disability Registry within 1 year of the index date were at even greater risk for MI (aHR=3.74, 95% CI=2.43-5.76), HF (aHR=3.96, 95% CI=3.05-5.14) and AF (aHR=3.32, 95% CI=2.18-5.05). SCI survivors who had cervical or lumber spinal injuries had a heightened risk of heart disease despite disability status compared with the matched controls, more so than those with a disability. SCI survivors who had thoracic injuries plus a disability also had significantly higher risk of heart disease compared with the control group. Overall, every population of SCI survivors is at significantly greater risk for MI, HF and AF compared with non-SCI patients, especially SCI survivors with a cervical level of injury and a disability. In an accompanying editorial, Christopher R. West, PhD, and Jacquelyn J. Cragg, PhD, both of the University of British Columbia, examined the relationship between SCI and cardiovascular disease, and new investigative potential for the field of SCI research. “Although curing paralysis remains the ‘holy grail’ of SCI research, a growing body of evidence suggests that recovery of nonmotor functions is a key priority for the field,” the editorialists wrote. “There is still comparatively little known about the onset, incidence, and type of CVD in the SCI population.” The editorialists noted the importance of the present study, as it contributes the first set of data on elevated cardiovascular risk in patients with lumbar SCI and cardiovascular dysfunction in patients who are not usually included in cardiovascular studies. “The definitive population level data provided by Yoo et al should act as ‘call-to-arms’ to researchers and clinicians to shift gears from tradition and begin studying the clinical efficacy of neuraxial therapies that could help restore autonomic balance, such as targeted neuromodulation,” the editorialists concluded. Sources: Yoo JE, Kim M, Kim B, et al. Increased Risk of Myocardial Infarction, Heart Failure, and Atrial Fibrillation After Spinal Cord Injury. J Am Coll Cardiol. 2024;83:741-751. West CR, Cragg JJ. Getting to the Heart of the Problem in Spinal Cord Injury. J Am Coll Cardiol. 2024;83:752-754. Image Credit: Peakstock – stock.adobe.com