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Cragg J.J.,University of Sfax | Noonan V.K.,Rick Hansen Institute | Krassioukov A.,International Collaboration on Repair Discoveries ICORD | Krassioukov A.,Strong Rehabilitation Center | And 3 more authors.
Neurology | Year: 2013

Objective: To evaluate the association between cardiovascular disease (CVD) and spinal cord injury (SCI) in a large representative sample. Methods: Data were compiled from more than 60,000 individuals from the 2010 cycle of the cross-sectional Canadian Community Health Survey (CCHS). Multivariable logistic regression analysis was conducted to examine this relationship, adjusting for confounders and using probability weighting to account for the CCHS sampling method. Results: After adjusting for age and sex, SCI was associated with a significant increased odds of heart disease (adjusted odds ratio [OR] 5 2.72, 95%confidence interval [CI] 1.94-3.82) and stroke (adjusted OR 5 3.72, 95% CI 2.22-6.23). Conclusions: These remarkably heightened odds highlight the exigent need for targeted interventions and prevention strategies addressing modifiable risk factors for CVD in individuals with SCI. © 2013 American Academy of Neurology. Source


Cragg J.J.,University of Sfax | Noonan V.K.,Rick Hansen Institute | Krassioukov A.,International Collaboration on Repair Discoveries | Krassioukov A.,Strong Rehabilitation Center | And 4 more authors.
Neurology | Year: 2013

Objective: The objective of this study was to evaluate the association between spinal cord injury (SCI) and type 2 diabetes in a large representative sample and to determine whether an association exists irrespective of known risk factors for type 2 diabetes. Methods: Data were obtained on 60,678 respondents to the Statistics Canada 2010 Cycle of the cross-sectional Canadian Community Health Survey. Multivariable logistic regression, incorporating adjustment for confounders and probability weights to account for the Canadian Community Health Survey sampling method, was conducted to quantify this association. Results: After adjustment for both sex and age, SCI was associated with a significant increased odds of type 2 diabetes (adjusted odds ratio 5 1.66, 95%confidence interval 1.16-2.36). These heightened odds persisted after additional adjustment for smoking status, hypertension status, body mass index, daily physical activity, alcohol intake, and daily consumption of fruits and vegetables (fully adjusted odds ratio 5 2.45, 95% confidence interval 1.34-4.47). Conclusions: There is a strong association between SCI and type 2 diabetes, which is not explained by known risk factors for type 2 diabetes. © 2013 American Academy of Neurology. Source


Hubli M.,University of British Columbia | Krassioukov A.V.,University of British Columbia | Krassioukov A.V.,Strong Rehabilitation Center
Journal of Neurotrauma | Year: 2014

Trauma to the spinal cord often results not only in sensorimotor but also autonomic impairments. The loss of autonomic control over the cardiovascular system can cause profound blood pressure (BP) derangements in subjects with spinal cord injury (SCI) and may therefore lead to increased cardiovascular disease (CVD) risk in this population. The use of ambulatory blood pressure monitoring (ABPM) allows insights into circadian BP profiles, which have been shown to be of good prognostic value for cardiovascular morbidity and mortality in able-bodied subjects. Past studies in SCI subjects using ABPM have shown that alterations in circadian BP patterns are dependent on the spinal lesion level. Tetraplegic subjects with sensorimotor complete lesions have a decreased daytime arterial BP, loss of the physiological nocturnal BP dip, and higher circadian BP variability, including potentially life-threatening hypertensive episodes known as autonomic dysreflexia (AD), compared with paraplegic and able-bodied subjects. The proposed underlying mechanisms of these adverse BP alterations mainly are attributed to a lost or decreased central drive to sympathetic spinal preganglionic neurons controlling the heart and blood vessels. In addition, several maladaptive anatomical changes within the spinal cord and the periphery, as well as the general decrease of physical daily activity in SCI subjects, account for adverse BP changes. ABPM enables the identification of adverse BP profiles and the associated increased risk for CVD in SCI subjects. Concurrently, it also might provide a useful clinical tool to monitor improvements of AD and lost nocturnal dip after appropriate treatments in the SCI population. © 2014 Mary Ann Liebert, Inc. Source


West C.R.,University of British Columbia | Wong S.C.,University of British Columbia | Krassioukov A.V.,University of British Columbia | Krassioukov A.V.,Strong Rehabilitation Center
Medicine and Science in Sports and Exercise | Year: 2014

INTRODUCTION: Disruption of autonomic control after spinal cord injury (SCI) results in life-threatening cardiovascular dysfunctions and impaired endurance performance; hence, an improved ability to recognize those at risk of autonomic disturbances is of critical clinical and sporting importance. PURPOSE: The objective of this study is to assess the effect of neurological level, along with motor, sensory, and autonomic completeness of injury, on cardiovascular control in Paralympic athletes with SCI. METHODS: Fifty-two highly trained male Paralympic athletes (age, 34.8 ± 7.1 yr) from 14 countries with chronic SCI (C2-L2) completed three experimental trials. During trial 1, motor and sensory functions were assessed according to the American Spinal Injury Association Impairment Scale. During trial 2, autonomic function was assessed via sympathetic skin responses (SSR). During trial 3, cardiovascular control was assessed via the beat-by-beat blood pressure response to orthostatic challenge. RESULTS: Athletes with cervical SCI exhibited the lowest seated blood pressure and the most severe orthostatic hypotension (P < 0.025). There were no differences in cardiovascular function between athletes with different American Spinal Injury Association Impairment Scale grades (P > 0.96). Conversely, those with the lowest SSR scores exhibited the lowest seated blood pressure and the most severe orthostatic hypotension (P < 0.002). Linear regression demonstrated that the combined model of neurological level and autonomic completeness of SCI explained the most variance in all blood pressure indices. CONCLUSION: We demonstrate for the first time that neurological level and SSR score provide the optimal combination of assessments to identify those at risk of abnormal cardiovascular control. We advocate the use of autonomic testing in the clinical and sporting classification of SCI athletes. Copyright © 2013 by the American College of Sports Medicine. Source


West C.R.,University of British Columbia | Bellantoni A.,University of British Columbia | Krassioukov A.V.,University of British Columbia | Krassioukov A.V.,Strong Rehabilitation Center
Topics in Spinal Cord Injury Rehabilitation | Year: 2013

Background: There is a clear relationship between the neurological level of spinal cord injury (SCI) and cardiovascular function; however, the relationship between completeness of injury and cardiovascular function is less straightforward. Traditionally completeness of injury has referred to neurological (motor/sensory) completeness. Recently, a number of studies have started to investigate autonomic completeness of injury. Objective: To investigate the relationships between cardiovascular function and neurological and autonomic completeness of injury. Methods: A literature search was conducted in November 2012 through MEDLINE, Embase, and CINAHL. Twenty-one studies were included in this review. Results: In acute SCI, there is no clear consensus about whether resting heart rate (HR), blood pressure (BP), or prevalence of BP abnormalities differs between neurologically complete and incomplete SCI. In chronic SCI, there is limited evidence that there is less prevalence of autonomic dysreflexia and improved heart rate variability in response to provocation in neurologically incomplete SCI; however, resting HR and BP appear similar between neurologically complete and incomplete SCI. There is growing evidence that BP and HR at rest and during orthostasis is enhanced in autonomically incomplete SCI. Numerous studies report that neurological completeness does not agree with autonomic completeness of injury. Conclusions: For acute SCI, there is no clear consensus whether cardiovascular function differs between complete and incomplete. For chronic SCI, the studies to date suggest that autonomic completeness of SCI is more strongly related to cardiovascular function than neurological completeness of injury. Thus, clinicians and scientists should account for autonomic completeness of injury when assessing cardiovascular function in SCI. © 2013 Thomas Land Publishers, Inc. Source

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