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Cardiovascular disease risk in adults with spastic bilateral cerebral palsy
OBJECTIVE: To explore: (i) cardiovascular disease risk factors and the 10-year clustered risk of a fatal cardiovascular event in adults with spastic bilateral cerebral palsy; and (ii) relationships between the 10-year risk and body fat, aerobic fitness and physical activity.
DESIGN: Cross-sectional study.
SUBJECTS: Forty-three adults with spastic bilateral cerebral palsy without severe cognitive impairment (mean age 36.6 years (standard deviation 6); 27 men).
METHODS: Biological and lifestyle-related risk factors and the 10-year risk according to the Systematic Coronary Risk Evaluation (SCORE) were assessed. Relationships were studied using multivariable linear regression analysis.
RESULTS: The following single risk factors were present: hypertension (n = 12), elevated total cholesterol (n = 3), low high-density lipoprotein cholesterol (n = 5; all men), high-risk waist circumference (n = 11), obesity (body mass index; n = 5; all men), reduced aerobic fitness (on average 80% of reference values), reduced level of everyday physical activity (on average 78% of reference values) and smoking (n=9). All participants had a 10-year risk <1%. Corrected for gender, participants with higher waist circumference (β = 0.28; p = 0.06) or body mass index (β=0.25; p = 0.08) tended to have a higher 10-year risk.
CONCLUSION: In this relatively young adult sample of people with spastic bilateral cerebral palsy several single cardiovascular disease risk factors were present. The 10-year fatal cardiovascular disease risk was low, and higher body fat tended to be related to higher 10-year risk.
Wilma M.A. van der Slot, Marij E. Roebroeck, Channah Nieuwenhuijsen, Michael P. Bergen, Henk J. Stam, Alex Burdorf, Rita J. G. van den Berg-Emons
Rijndam Rehabilitation Centre Westersingel 300, 3015 LJ Rotterdam, The Netherlands
2. Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL, Jr, et al. Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension 2003; 42: 1206–1252.
3. World Health Organization (WHO). Reports: Obesity: preventing and managing the global epidemic obesity (2000); The European health report, WHO Regional Publications, Copenhagen (2002); Definition and diagnosis of diabetes mellitus and intermediate hyperglycaemia (2006); Waist circumference and waist-hip ratio (2008); Global database on body mass index (2006). [Accessed 2011]. Available from: http://www.who.int/rpc/guidelines/en.
4. Pate RR, Pratt M, Blair SN, Haskell WL, Macera CA, Bouchard C, et al. Physical activity and public health. A recommendation from the Centers for Disease Control and Prevention and the American College of Sports Medicine. JAMA 1995; 273: 402–407.
5. Twisk JW, Kemper HC, van Mechelen W. The relationship between physical fitness and physical activity during adolescence and cardiovascular disease risk factors at adult age. The Amsterdam Growth and Health Longitudinal Study. Int J Sports Med 2002; 23 Suppl 1: S8–S14.
6. van Leest LATM, van Dis I, Verschuren WMM. Risk factors for cardiovascular disease in the Dutch population. [Accessed 2011]. Available from: http://www.hartstichting.nl/hartstichting/voorlichting/overzicht. The Hague: Netherlands Heart Foundation; 2006.
7. Bauman WA. The potential metabolic consequences of cerebral palsy: inferences from the general population and persons with spinal cord injury. Dev Med Child Neurol 2009; 51 Suppl 4: 64–78.
8. Nieuwenhuijsen C, van der Slot WM, Dallmeijer AJ, Janssens PJ, Stam HJ, Roebroeck ME, et al. Physical fitness, everyday physical activity, and fatigue in ambulatory adults with bilateral spastic cerebral palsy. Scand J Med Sci Sports 2010; 21: 535–542.
9. Verschuren O, Ketelaar M, Gorter JW, Helders PJ, Uiterwaal CS, Takken T. Exercise training program in children and adolescents with cerebral palsy: a randomized controlled trial. Arch Pediatr Adolesc Med 2007; 161: 1075–1081.
10. Bjornson KF, Belza B, Kartin D, Logsdon R, McLaughlin JF. Ambulatory physical activity performance in youth with cerebral palsy and youth who are developing typically. Phys Ther 2007; 87: 248–257.
11. Nieuwenhuijsen C, van der Slot WM, Beelen A, Arendzen JH, Roebroeck ME, Stam HJ, et al. Inactive lifestyle in adults with bilateral spastic cerebral palsy. J Rehabil Med 2009; 41: 375–381.
12. van den Berg-Emons HJ, Saris WH, de Barbanson DC, Westerterp KR, Huson A, van Baak MA. Daily physical activity of schoolchildren with spastic diplegia and of healthy control subjects. J Pediatr 1995; 127: 578–584.
13. van den Berg-Emons RJ, Bussmann JB, Stam HJ. Accelerometry-based activity spectrum in persons with chronic physical conditions. Arch Phys Med Rehabil 2010; 91: 1856–1861.
14. Strauss D, Cable W, Shavelle R. Causes of excess mortality in cerebral palsy. Dev Med Child Neurol 1999; 41: 580–585.
15. Hemming K, Hutton JL, Pharoah PO. Long-term survival for a cohort of adults with cerebral palsy. Dev Med Child Neurol 2006; 48: 90–95.
16. Hombergen SP, Huisstede BM, Streur MF, Stam HJ, Slaman J, Bussmann JB, et al. Impact of cerebral palsy on health-related physical fitness in adults: systematic review. Arch Phys Med Rehabil 2012; 93: 871–881.
17. Hurvitz EA, Green LB, Hornyak JE, Khurana SR, Koch LG. Body mass index measures in children with cerebral palsy related to gross motor function classification: a clinic-based study. Am J Phys Med Rehabil 2008; 87: 395–403.
18. Park ES, Chang WH, Park JH, Yoo JK, Kim SM, Rha DW. Childhood obesity in ambulatory children and adolescents with spastic cerebral palsy in Korea. Neuropediatrics 2011; 42: 60–66.
19. Fernandez JE, Pitetti KH, Betzen MT. Physiological capacities of individuals with cerebral palsy. Hum Factors 1990; 32: 457–466.
20. van der Slot WM, Roebroeck ME, Landkroon AP, Terburg M, Berg-Emons RJ, Stam HJ. Everyday physical activity and community participation of adults with hemiplegic cerebral palsy. Disabil Rehabil 2007; 29: 179–189.
21. Turk MA, Geremski CA, Rosenbaum PF, Weber RJ. The health status of women with cerebral palsy. Arch Phys Med Rehabil 1997; 78: 10–17.
22. Peterson MD, Haapala HJ, Hurvitz EA. Predictors of cardiometabolic risk among adults with cerebral palsy. Arch Phys Med Rehabil 2012; 93: 816–821.
23. Conroy RM, Pyorala K, Fitzgerald AP, Sans S, Menotti A, De Backer G, et al. Estimation of ten-year risk of fatal cardiovascular disease in Europe: the SCORE project. Eur Heart J 2003; 24: 987–1003.
24. van der Slot WM, Nieuwenhuijsen C, van den Berg-Emons RJ, Wensink-Boonstra AE, Stam HJ, Roebroeck ME. Participation and health-related quality of life in adults with spastic bilateral cerebral palsy and the role of self-efficacy. J Rehabil Med 2010; 42: 528–535.
25. Cans C. Surveillance of cerebral palsy (SCPE) in Europe: a collaboration of cerebral palsy surveys and registers. Dev Med Child Neurol 2000; 42: 816–824.
26. Palisano R, Rosenbaum P, Walter S, Russell D, Wood E, Galuppi B. Development and reliability of a system to classify gross motor function in children with cerebral palsy. Dev Med Child Neurol 1997; 39: 214–223.
27. National Cholesterol Education Program Expert Panel on Detection Evaluation and Treatment of High Blood Cholesterol in Adults. Third report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Circulation 2002; 106: 3143–1421.
28. Blokstra A, Smit HA, Bueno de Mesquita HB, Seidell JC, Verschuren WMM. Monitoring Project on Chronic Disease Risk Factors (MORGEN-project) 1993–1997: prevalences and trends in lifestyle and risk. Report No.: 263200008/2005. Bilthoven: National Institute of Public Health and the Environment (RIVM); 2005.
29. Waninge A, Ligthart KA, Kramer J, Hoeve S, van der Schans CP, Haisma HH. Measuring waist circumference in disabled adults. Res Dev Disabil 2010; 31: 839–847.
30. Lean ME, Han TS, Morrison CE. Waist circumference as a measure for indicating need for weight management. BMJ 1995; 311: 158–161.
31. De Backer G, Ambrosioni E, Borch-Johnsen K, Brotons C, Cifkova R, Dallongeville J, et al. European guidelines on cardiovascular disease prevention in clinical practice. Third Joint Task Force of European and Other Societies on Cardiovascular Disease Prevention in Clinical Practice. Eur Heart J 2003; 24: 1601–1610.
32. van Dis I, Kromhout D, Geleijnse JM, Boer JM, Verschuren WM. Evaluation of cardiovascular risk predicted by different SCORE equations: The Netherlands as an example. Eur J Cardiovasc Prev Rehabil 2010; 17: 244–249.
33. Shvartz E, Rebold RC. Aerobic fitness norms for males and females aged 6 to 75 years: a review. Aviat Space Environ Med 1990; 61: 3–11.
34. Martin AA, Cotie LM, Timmons BW, Gorter JW, Macdonald MJ. Arterial structure and function in ambulatory adolescents with cerebral palsy are not different from healthy controls. Int J Pediatr 2012; Article ID: 168209.
35. Williams PT. Physical fitness and activity as separate heart disease risk factors: a meta-analysis. Med Sci Sports Exerc 2001; 33: 754–761.
36. Hasselstrom H, Hansen SE, Froberg K, Andersen LB. Physical fitness and physical activity during adolescence as predictors of cardiovascular disease risk in young adulthood. Danish Youth and Sports Study. An eight-year follow-up study. Int J Sports Med 2002; 23 Suppl 1: S27–S31.
37. van der Dussen L, Nieuwstraten W, Roebroeck M, Stam HJ. Functional level of young adults with cerebral palsy. Clin Rehabil 2001; 15: 84–91.
38. Mora S, Rifai N, Buring JE, Ridker PM. Fasting compared with nonfasting lipids and apolipoproteins for predicting incident cardiovascular events. Circulation 2008; 118: 993–1001.
39. Nordestgaard BG, Langsted A, Freiberg JJ. Nonfasting hyperlipidemia and cardiovascular disease. Current Drug Targets 2009; 10: 328–335.
40. White DK, Wagenaar RC, Del Olmo ME, Ellis TD. Test-retest reliability of 24 hours of activity monitoring in individuals with Parkinson’s disease in home and community. Neurorehabil Neural Repair 2007; 21: 327–340.
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