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Increased Risk of MI, HF, and AF After Spinal Cord Injury
Quick Takes
- Using data from the Korean National Health Insurance Service and National Disability Registry, spinal cord injury (SCI) survivors in Korea were found to have higher risk for subsequent MI, HF, or AF compared to matched controls without SCI.
- Severe disability and cervical- or lumbar-level SCI were associated with relatively higher risks of heart disease.
Study Questions:
What is the incidence of heart disease among spinal cord injury (SCI) survivors compared to the non-SCI population?
Methods:
Data from the Korean National Health Insurance Service (NHIS) were used to identify SCI survivors ≥20 years of age whose injury occurred between 2010 and 2018 and who had undergone health screening within 2 years prior to the SCI diagnosis. After excluding patients diagnosed with myocardial infarction (MI), heart failure (HF), or atrial fibrillation (AF) prior to SCI, 1:3 matching based on age, sex, and year was performed to yield a study group of 5,083 SCI survivors and 19,320 controls. Data from the Ministry of Health and Welfare National Disability Registry (NDR) were used to categorize SCI disabilities as mild (grades 4-6) or severe (grades 1-3); SCI survivors not registered in the NDR within 1 year of SCI were considered to be not disabled. The study endpoints were new-onset MI, HF, or AF based on International Classification of Diseases, 10th Revision (ICD-10) codes; the cohort was followed from the index date (diagnosis date for SCI or corresponding date for matched controls) until 2019.
Results:
Compared to controls, SCI survivors had a higher 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). Risks were further increased in the setting of SCI with disability: SCI survivors with severe disability had the highest risks of 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). Cervical and lumbar SCI survivors had increased risks of heart disease regardless of disability compared to matched controls, and those risks were slightly higher among those with disability compared to SCI survivors without disability. For thoracic SCI survivors, only those with disability had significantly increased risk of MI or HF compared to matched controls.
Conclusions:
SCI survivors were at significantly greater risk for heart disease than were non-SCI controls, with higher risks among those with SCI and severe disability. The authors conclude that clinicians should be aware of the importance of heart disease among SCI survivors.
Perspective:
This large study using administrative data from the Republic of Korea found that SCI survivors were at significantly higher risk of new-onset MI, HF, and AF compared to the non-SCI population; with risks that were highest among SCI survivors with disability and those with cervical-level or lumbar-level SCI. Potential mechanisms could include the exaggeration of traditional cardiovascular risk factors among SCI survivors (including abnormalities in blood pressure control and glycemic control, dyslipidemia, and physical inactivity) and SCI as a chronic, low-grade inflammatory state. Especially considering potentially impaired perception of chest pain among SCI survivors in the setting of ischemic disease, this study reinforces the role of awareness among clinicians of increased heart disease risks among SCI survivors.
Clinical Topics: Acute Coronary Syndromes, Prevention
Keywords: Heart Disease Risk Factors, Spinal Cord Injuries
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