The Swedish Spinal Cord Injury Study on Cardiopulmonary and Autonomic Impairment
Condition: Spinal Cord Injuries; Cardiovascular Diseases; Pulmonary Disease; Autonomic Dysfunction
MeSH terms: Spinal Cord Injuries; Autonomic Nervous System Diseases; Primary Dysautonomias; Cardiovascular Diseases; Wounds and Injuries
Study type: Observational

Summary: 
      The main aim of this study is to gain an in-depth knowledge of cardiopulmonary and autonomic
      health consequences, and related risk factors among people with long-term high-level spinal
      cord injury. The result of this study will form the basis for further research to improve
      prevention strategies and risk prediction of cardiopulmonary disorders in people with spinal
      cord injury.
    

Detailed description: 
      Life expectancy for people with spinal cord injury (SCI) has increased during the 20th
      century as a result of improvements in health care systems and the environment. The incidence
      of SCI is stable and as a consequence the prevalence of SCI has increased globally leading to
      a growing population of persons aging with SCI. Therefore, SCI research need to focus on the
      physiology of aging to prevent premature cardiovascular and pulmonary diseases, which are the
      leading causes of death.

      The disruption of sensory-, motor- and autonomic pathways causes major neurological deficits
      which alter the physiologic conditions. Among people with SCI above the mid-thoracic level
      dysfunction in pulmonary, autonomic cardiovascular regulation and emerging metabolic
      cardiovascular risk factors are well-known. In addition, paralysis of the abdominal and
      thoracic musculature causes restrictive pulmonary dysfunction, weak cough and atelectasis
      contributing to the mortality in SCI.

      Cardiovascular disease (CVD) is more prevalent and occurs earlier in life among people with
      SCI compared to the general population. The increased prevalence of traditional risk factors
      cannot, however, fully explain these findings. Cardiovascular autonomic dysfunction has been
      hypothesized to contribute to the increased risk. The need for advances in risk management is
      therefore important as the first symptoms of coronary atherosclerosis are commonly sudden
      death or acute coronary syndrome. This is further complicated by the sensory loss and reduced
      ability to perform strenuous activities leading to asymptomatic disease as typical symptoms
      of exertional angina pectoris does not manifest. Risk assessment tools, such as Framingham
      risk score or Systematic Coronary Risk Evaluation (SCORE), are available but lack the
      precision in people with SCI as these tools are calibrated on the general population.

      The Swedish Spinal Cord Injury Study on Cardiopulmonary and Autonomic Impairment - SPICA -
      was initiated to assess the effects of aging with SCI on the cardiovascular, pulmonary and
      autonomic systems in a cohort of middle-aged persons with long-term SCI. SPICA combines
      advanced imaging techniques, likely to play an important role in risk stratification of CVD
      and pulmonary disease in the future, with functional analyses, and generic and SCI-specific
      assessment tools.

      The overarching aim of SPICA is to assess and extensively characterize the cardiopulmonary
      and autonomic health status in middle-aged persons with a severe and high-level SCI. The
      study will elucidate the cardiopulmonary health consequences specific to persons living with
      a SCI through comparison of results to matched controls. The results of SPICA will advance
      the investigator's knowledge in this field and thereby improve prevention strategies and risk
      prediction of CVD and pulmonary disorders in people with SCI.
    

Observational model: Case-Control
Time perspective: Cross-Sectional
Sampling method: Non-Probability Sample
Study population: 
        The total SCI population matching the inclusion criteria in Skåne, Sweden (n=38).
      
Biospecimen description: 
      Serum, plasma-EDTA, plasma-Citrate plasma li-heparin, DNA EDTA-whole blood
    
Keywords: Epidemiology; Rehabilitation; Clinical protocols; Middle aged