Evaluation of cardiovascular disease risk in individuals with chronic spinal cord injury


Study design

Multicentre, cross-sectional study.


To identify which markers of obesity, injury characteristics and autonomic function variables are related to cardiovascular disease (CVD) risk after spinal cord injury (SCI), and establish cut-points for detection and risk management.


Eight SCI rehabilitation centres in the Netherlands.


Individuals (n = 257) with a traumatic, chronic (≥10 years) SCI, with age at injury between 18 and 35 years, completed a self-report questionnaire and a one-day visit to a rehabilitation centre for testing. Three anthropometric measures were tested: body mass index (BMI); waist circumference (WC); and waist-to-height ratio (WHtR). Injury characteristics included: American Spinal Injury Association impairment scale (AIS); duration of injury (DOI); and neurological level of injury (LOI). Cardiovascular autonomic function was assessed from peak heart rate during maximal exercise (HRpeak). Systolic arterial pressure (SAP) and aerobic capacity (VO2peak) were also determined. CVD risk was calculated using the Framingham risk score (FRS).


All anthropometric variables were associated with FRS, with WC showing the strongest correlation (r = 0.41, p < 0.001) and greatest area under the curve (0.73) for 10-year CVD risk (%). WC, DOI, SAP, HRpeak, LOI, and VO2peak (variable importance: 0.81, 1.0, 0.98, 0.98, 0.66, 0.68, respectively) were important predictive variables for 10-year CVD risk in individuals with SCI.


We confirm that WC is a simple, practical measure of CVD risk, and along with DOI and markers of cardiovascular autonomic function, plays a role in the increased CVD risk following SCI.

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Fig. 1: Receiver operator characteristic (ROC) curves showing the ability of markers of obesity to predict an adverse Framingham Risk Score.
Fig. 2: Akaike Information Criterion model-averaged importance of predictors of CVD risk.
Fig. 3: Unbiased recursive partitioning (URP) conditional inference tree for CVD risk after traumatic SCI.

Data availability

The datasets generated and/or analysed during the current study are available from the corresponding author on reasonable request.


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We are grateful to Ms Brooke Hockin and Ms Natalie Heeney for their careful review of the paper.


This study is part of the Dutch ALLRISC research program and is supported financially by ZonMw Rehabilitation program and Fonds NutsOhra, grant no. 89000006.

Author information




JJC, JKK, MCD and VEC conceived the idea for the study. MWMP and SDG designed the study protocol and collected the data. MCD and VEC analysed the data and interpreted the results. JJC, JKK, MWMP, SDG, TML and VEML assisted in interpreting the results. MCD and VEC wrote the paper. VEC supervised the research. All authors contributed to the critical revision of the paper.

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Correspondence to Victoria E. Claydon.

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Dorton, M.C., Lucci, VE.M., de Groot, S. et al. Evaluation of cardiovascular disease risk in individuals with chronic spinal cord injury. Spinal Cord (2020). https://doi.org/10.1038/s41393-020-00566-5

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