The neurological level of spinal cord injury and cardiovascular risk factors: a systematic review and meta-analysis.

Raguindin, Peter Francis; Fränkl, Gion; Itodo, Oche Adam; Bertolo, Alessandro; Zeh, Ramona Maria; Capossela, Simona; Minder, Beatrice; Stoyanov, Jivko; Stucki, Gerold; Franco Duran, Oscar H.; Muka, Taulant; Glisic, Marija (2021). The neurological level of spinal cord injury and cardiovascular risk factors: a systematic review and meta-analysis. Spinal cord, 59(11), pp. 1135-1145. Springer Nature 10.1038/s41393-021-00678-6

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Systematic review and meta-analysis.


To determine the difference in cardiovascular risk factors (blood pressure, lipid profile, and markers of glucose metabolism and inflammation) according to the neurological level of spinal cord injury (SCI).


We searched 5 electronic databases from inception until July 4, 2020. Data were extracted by two independent reviewers using a pre-defined data collection form. The pooled effect estimate was computed using random-effects models, and heterogeneity was calculated using I2 statistic and chi-squared test (CRD42020166162).


We screened 4863 abstracts, of which 47 studies with 3878 participants (3280 males, 526 females, 72 sex unknown) were included in the meta-analysis. Compared to paraplegia, individuals with tetraplegia had lower systolic and diastolic blood pressure (unadjusted weighted mean difference, -14.5 mmHg, 95% CI -19.2, -9.9; -7.0 mmHg 95% CI -9.2, -4.8, respectively), lower triglycerides (-10.9 mg/dL, 95% CI -19.7, -2.1), total cholesterol (-9.9 mg/dL, 95% CI -14.5, -5.4), high-density lipoprotein (-1.7 mg/dL, 95% CI -3.3, -0.2) and low-density lipoprotein (-5.8 mg/dL, 95% CI -9.0, -2.5). Comparing individuals with high- vs. low-thoracic SCI, persons with higher injury had lower systolic and diastolic blood pressure (-10.3 mmHg, 95% CI -13.4, -7.1; -5.3 mmHg 95% CI -7.5, -3.2, respectively), while no differences were found for low-density lipoprotein, serum glucose, insulin, and inflammation markers. High heterogeneity was partially explained by age, prevalent cardiovascular diseases and medication use, body mass index, sample size, and quality of studies.


In SCI individuals, the level of injury may be an additional non-modifiable cardiovascular risk factor. Future well-designed longitudinal studies with sufficient follow-up and providing sex-stratified analyses should confirm our findings and explore the role of SCI level in cardiovascular health and overall prognosis and survival.

Item Type:

Journal Article (Original Article)


04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Social and Preventive Medicine (ISPM)
13 Central Units > Administrative Director's Office > University Library of Bern

Graduate School:

Graduate School for Cellular and Biomedical Sciences (GCB)
Graduate School for Health Sciences (GHS)

UniBE Contributor:

Raguindin, Peter Francis, Itodo, Oche Adam, Minder, Beatrice, Franco Duran, Oscar Horacio, Muka, Taulant, Glisic, Marija


600 Technology > 610 Medicine & health
300 Social sciences, sociology & anthropology > 360 Social problems & social services
000 Computer science, knowledge & systems > 020 Library & information sciences




Springer Nature




Doris Kopp Heim

Date Deposited:

30 Aug 2021 15:46

Last Modified:

18 Jan 2023 11:02

Publisher DOI:


PubMed ID:


Additional Information:

Open Access funding provided by University of Bern.




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