Emerging evidence for accelerated ageing and cardiovascular disease in individuals with cerebral palsy
Patrick G. McPhee, Maureen J. MacDonald, Jem L. Cheng, Emily C. Dunford, Jan Willem Gorter
School of Rehabilitation Science, McMaster University, , L7T 3Z6 Hamilton, Canada. E-mail: firstname.lastname@example.org
Preview of fully accepted paper, still not published in any volume
Objective: To examine longitudinal changes in traditional and non-traditional risk factors for cardiovascular disease in individuals with cerebral palsy and to investigate relationships between age, Gross Motor Function Classification System (GMFCS) and risk of cardiovascular disease.
Methods: Individuals with cerebral palsy (n = 28 of 53 eligible participants; GMFCS levels I–V; follow-up mean age 35.1 years (standard deviation (SD) 14.4) participated in a longitudinal cohort study with 4.0 years (SD 1.2) follow-up. Traditional risk factors included waist circumference and systolic blood pressure. Non-traditional risk factors included carotid artery intima media thickness and distensibility, carotid-femoral pulse wave velocity, and flow-mediated dilation.
Results: Absolute (0.31 mm (SD 0.13) vs 0.22 mm (SD 0.08) , p = 0.045, 95% confidence interval (95% CI) 0.040, 0.151) and relative flow-mediated dilation (9.9 % (SD 4.7) vs 7.5 % (SD 2.6), p = 0.049, 95% CI 0.464, 4.42) decreased, while carotid artery intima media thickness (0.52 mm (SD 0.17) vs 0.67 mm (SD 0.33), p = 0.041, 95% CI –0.242, –0.074) increased from baseline to follow-up. No other risk factor changed significantly. Age at baseline was a significant independent predictor of carotid artery intima media thickness change (R-squared = 0.261, p = 0.031).
Conclusion: Individuals with cerebral palsy experience significant changes in non-traditional risk factors for cardiovascular disease over 4 years, in the face of no changes in traditional risk factors. Compared with findings in the literature from the general population, these risk factors progress at a faster rate and at a younger age in individuals with cerebral palsy.
Recent research has shown that individuals with cerebral palsy are at increased risk of developing cardiovascular disease compared with the general population. However, no studies have investigated the progression of risk of cardiovascular disease in individuals with cerebral palsy over time. This study measured risk factors for cardiovascular disease in 28 individuals with cerebral palsy over a 4-year time period. Some risk factors for cardiovascular disease appeared to progress at a faster rate and at a younger age in people with cerebral palsy compared with the general population. It is recommended that clinicians measure risk factors for cardiovascular disease in this population early on, in order to prevent the development of cardiovascular disease later in life.
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