Cardiovascular Risk in Individuals with Spinal Cord Injury.

Itodo, Oche Adam (2022). Cardiovascular Risk in Individuals with Spinal Cord Injury. (Unpublished). (Dissertation, University of Bern, the Faculty of Medicine and the Faculty of Human Sciences)

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Cardiovascular diseases (CVD) ranks among the top causes of mortality among individuals with Spinal Cord Injury (SCI) due to a constellation of factors like accelerated aging associated with SCI, the inability to participate fully in physical activity (PA) due to physical, psychological and environmental barriers linked with SCI and low hormonal levels like testosterone that exacerbate CVD in this population. The evidence is however lacking on 1) whether physically active SCI individuals as compared to inactive or less active individuals have truly better cardiometabolic risk profile, 2) how cardiometabolic risks factors changes within inpatient rehabilitation and whether the risk differs between individuals with traumatic (TSCI) and non-traumatic SCI (NTSCI), and 3) how androgen levels change longitudinally in within initial inpatient rehabilitation in this population and which clinical/injury characteristics are associated with hormone levels. The overall aim of this thesis was to investigate modifiable and non-modifiable CVD risk factors in the context of SCI. In particular, we aimed to 1) understand how cardiometabolic diseases risk factors differ in physically active individuals SCI compared to physically inactive individuals with SCI and what injury specific as well as factors that could affect it. 2) to investigate changes in intermediate cardiometabolic risk factors between beginning and end of rehabilitation in TSCI and NTSCI. 3) to investigate how androgen levels change in individuals with SCI within the first year of injury in inpatient rehabilitation and to study the injury characteristics associated with these changes. First, I applied systematic review and meta-analysis techniques to summarize literature composed of 5500 individuals with SCI to investigate the association between PA and cardiometabolic risk factors in individuals with SCI. Secondly, I used linear mixed models and univariate linear regression to analyze data from Swiss Spinal Cord Injury Cohort (SwiSCI) cohort including 530 individuals to study longitudinal changes in cardiometabolic risk factors during initial inpatient rehabilitation. Lastly, we measured total testosterone, free testosterone, sex hormone binding globulin, dehydroepiandrosterone, dehydroepiandrosterone sulfate, using Enzyme Linked immunosorbent Assay (ELISA) and explored longitudinal changes in androgen levels during inpatient rehabilitation and applied univariate linear regression to identify clinical/injury characteristics associated with hormone levels. In this thesis, I contribute to knowledge by elucidating the roles that cardiovascular risk factors play in individuals who have acquired or live with SCI. In these individuals, cardiovascular health could be improved with respect to glucose metabolism, blood lipid profiles and cardiorespiratory fitness through participation in moderate to vigorous physical activity. Furthermore, I was able to confirm improvements in overall cardiovascular health and highlight the need to secure long-term survival in the context of CVD among individuals with SCI through the continuation of targeted preventive measures via effective SCI management. In addition, I was able to identify additional determinants of androgen levels in individuals with SCI which could help in the development of further studies capable of specifically exploring the roles of these determinants and lifestyle factors that are responsible for CVD in this population. Finally, the culmination of these findings implies that physical activity, androgen levels and injury characteristics are important aspects to consider to improve the overall wellbeing of individuals with SCI.

Item Type:	Thesis (Dissertation)
Division/Institute:	04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Social and Preventive Medicine (ISPM)
Graduate School:	Graduate School for Health Sciences (GHS)
UniBE Contributor:	Itodo, Oche Adam, Franco Duran, Oscar Horacio, Glisic, Marija, Stoyanov, Jivko
Subjects:	600 Technology > 610 Medicine & health 300 Social sciences, sociology & anthropology > 360 Social problems & social services
Language:	English
Submitter:	Doris Kopp Heim
Date Deposited:	11 Jul 2024 15:09
Last Modified:	11 Jul 2024 15:09
Additional Information:	PhD in Health Sciences (Epidemiology)
URI:	https://boris.unibe.ch/id/eprint/198915