Cardiometabolic syndrome
Cardiometabolic syndrome (also known as metabolic syndrome, or syndrome X) is a distinct condition that occurs when at least three of the following co-exist in an individual:
- Abdominal obesity
- Hypertension
- Insulin resistance
- Dyslipidaemia: elevated triglycerides and/or reduced high density lipoprotein (HDL cholesterol)
Cardiometabolic syndrome contributes significantly to cardiometabolic risk, which is the likelihood of a person developing cardiometabolic diseases including cardiovascular disease, diabetes, kidney failure and liver disease.
Cardiometabolic syndrome and spinal cord injury
People with spinal cord injury (SCI) are more likely to develop cardiometabolic syndrome compared to people without SCI, and at a much earlier age. This is predominantly driven by changes to energy requirements and body composition which lead to weight gain, abdominal obesity and increased adipose (fat) tissue. In individuals with SCI who are obese, this adipose tissue secretes harmful molecules that lead to systemic inflammation, insulin resistance and dyslipidaemia.
Other factors unique to SCI also contribute to development of cardiometabolic syndrome and overall cardiometabolic risk. Research indicates that sympathetic nervous system dysfunction, hormonal changes including a reduction in the anabolic hormone testosterone and increased leptin, time since injury, level and completeness of SCI also play a role. This is in addition to traditional risk factors such as age, sex and family history.
The below diagram illustrates the factors that contribute to cardiometabolic risk in a person with SCI described above. Of all cardiometabolic diseases, cardiovascular disease has emerged as the leading cause of death in people with SCI.
Farkas, Gary J., Adam M. Burton, David W. McMillan, Alicia Sneij, and David R. Gater, Jr. 2022. “The Diagnosis and Management of Cardiometabolic Risk and Cardiometabolic Syndrome after Spinal Cord Injury” Journal of Personalized Medicine 12, no. 7: 1088. https://doi.org/10.3390/jpm12071088
See optimising cardiometabolic health for further information.
References and further reading
Després JP, Larose E, Poirier P. Obesity and Cardiometabolic Disease. In: Zipes DP et al editors. Brunwald’s Heart Disease: a Textbook of Cardiovascular Medicine. Eleventh ed., Elsevier/Saunders, 2018. p. 998-1006.
Farkas GJ, Burton AM, McMillan DW, Sneij A, Gater DR Jr. The Diagnosis and Management of Cardiometabolic Risk and Cardiometabolic Syndrome after Spinal Cord Injury. J Pers Med. 2022 Jun 30;12(7):1088.
Kressler J, Cowan RE, Bigford GE, Nash MS. Reducing cardiometabolic disease in spinal cord injury. Phys Med Rehabil Clin N Am. 2014 Aug;25(3):573-604.
Nash MS, Groah SL, Gater DR Jr, Dyson-Hudson TA, Lieberman JA, Myers J, Sabharwal S, Taylor AJ; Consortium for Spinal Cord Medicine. Identification and Management of Cardiometabolic Risk after Spinal Cord Injury: Clinical Practice Guideline for Health Care Providers. Top Spinal Cord Inj Rehabil. 2018 Fall;24(4):379-423.
West CR, Mills P, Krassioukov AV. Influence of the neurological level of spinal cord injury on cardiovascular outcomes in humans: a meta-analysis. Spinal Cord. 2012 Jul;50(7):484-92.