Establishing a threshold to predict risk of cardiovascular disease from the serum triglyceride and high-density lipoprotein concentrations in persons with spinal cord injury

Spinal Cord, 2018 · DOI: 10.1038/s41393-018-0187-7 · Published: November 1, 2018

Spinal Cord Injury Cardiovascular Science Genetics

Simple Explanation

This study aimed to find out if the levels of triglycerides (TG) that indicate a risk for heart disease are different in people with spinal cord injury (SCI) compared to those without SCI. The researchers looked at the relationship between TG and HDL-C (good cholesterol) in people with different levels of SCI and compared them to able-bodied individuals. They found that people with SCI, especially those with injuries at or above the T4 vertebra, might be at risk for heart disease at lower TG levels than what is considered normal for the general population.

Study Duration

Not specified

Participants

578 participants: 223 with SCI ↑T4, 178 with SCI ↓T5, and 177 AB

Evidence Level

Level 3; Retrospective Cohort

Key Findings

1
The serum TG concentration that intersects with a serum HDL-C of 40 mg/dl is lower in persons with SCI than in the general population.
2
In individuals with SCI above T4, a TG concentration >115 mg/dl should be considered elevated, especially when HDL-C concentrations are ≤ 40 mg/dl.
3
The serum TG concentration was determined to be 137 mg/dl in the SCI ↓T5 group, similar to AB participants.

Research Summary

This report explores the relationship between circulating TG and HDL-C concentrations, and more specifically, the serum TG concentrations at which serum HDL-C equals 40 mg/dl in SCI cohorts that are assumed to have spared (↓T5) or functionally impaired (↑T4) SNS innervation to the liver and abdominal tissues. Linear regression analysis revealed that the serum TG concentration that intersects with serum HDL-C concentration at 40 mg/dl was 121 mg/dl in SCI ↑T4 and 137 mg/dl in SCI ↓T5 group. Our statistical modeling suggests that the serum TG concentration threshold associated with increased risk of CVD in individuals with SCI ↑T4 is 115 mg/dl, and in those with SCI ↓T5 is 137 mg/dl.

Practical Implications

Revised Screening Thresholds

Clinicians should consider lower TG concentration thresholds for CVD risk assessment in SCI patients, especially those with injuries at or above T4.

Early Intervention

Lifestyle and pharmacological interventions should be considered at lower TG concentrations in SCI patients to reduce CVD risk.

Further Research

Clinical trials are needed to evaluate the efficacy of interventions to modify lipoprotein profiles and mitigate CVD risk in the SCI population.

Study Limitations

1
Specific details of the subject history that may have influenced the data were not available, such as cigarette smoking, and alcohol intake.
2
The moderate strength of the TG and HDL-C relationship presented limits the accuracy of all the predictive models used as demonstrated by AUC values that ranged from 0.65–0.72.
3
Future studies are needed in a comparable sample size to that described herein with the ability to assess the value of adding multiple predictors for a stronger model that can account for a greater degree of the variance in the prediction of TG cutoff values.

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