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Cardiometabolic factors in middle-aged people with long-term cervical and upper thoracic spinal cord injuries
Mattias Hill1,2, Sophie Jörgensen1,2, Gunnar Engström3
1Department of Health Sciences, Lund University, Lund, Sweden.
Insights
Middle-aged individuals with spinal cord injury (SCI) show compromised cardiometabolic health, with higher arterial stiffness and advanced glycation end products (AGE) compared to the general population. These findings highlight the need for further research into long-term SCI impacts.
Area of Science:
- Cardiovascular Health
- Neurology
- Metabolic Health
Background:
- Spinal cord injury (SCI) can significantly impact long-term health, particularly cardiometabolic function.
- Middle-aged individuals with cervical and upper thoracic SCI may experience unique physiological changes.
- Understanding these changes is crucial for proactive health management in the SCI population.
Purpose of the Study:
- To assess arterial stiffness, ankle-brachial index (ABI), advanced glycation end products (AGE), and glycosylated hemoglobin (HbA1c).
- To compare these cardiometabolic markers in middle-aged individuals with cervical/upper thoracic SCI against a general population cohort.
- To identify potential long-term health implications of SCI on cardiovascular and metabolic systems.
Main Methods:
- A cross-sectional study design comparing 25 participants with SCI to 250 matched controls from the general population.
- Measurements included Aortic augmentation index at heart rate of 75 bpm (Aortic Aix@75), pulse wave velocity, ABI, AGE, and HbA1c.
- Participants were recruited from a tertiary outpatient SCI unit, with controls from the Swedish CArdioPulmonary bioImage Study (SCAPIS).
Main Results:
- Individuals with SCI exhibited significantly higher Aortic Aix@75 and AGE levels.
- Lower ABI and HbA1c were observed in the SCI group compared to controls.
- While pulse wave velocity was similar, abnormal HbA1c levels were more prevalent in the SCI cohort.
Conclusions:
- Middle-aged individuals with long-term cervical and upper thoracic SCI demonstrate compromised cardiometabolic health.
- The observed differences in arterial stiffness and metabolic markers suggest a heightened risk profile.
- Further investigation is warranted to determine the prognostic significance of these cardiometabolic alterations in SCI.
Objective:
To describe arterial stiffness, ankle-brachial index (ABI), advanced glycation end products (AGE) and glycosylated hemoglobin (HbA1c) in middle-aged people with cervical and upper thoracic SCI, and compare findings with the general population.
Design:
Cross-sectional study with matched controls.
Setting:
Tertiary outpatient SCI unit in southern Sweden.
Participants:
Participants (n = 25) in the Swedish Spinal Cord Injury Study on Cardiopulmonary and Autonomic Impairment (SPICA) (20% women, mean age 58 years, mean time since injury 28 years, injury levels C2-T6, American Spinal Injury Association Impairment Scale A-C). Controls (n = 250; ratio 10:1) from the general population were obtained from the Swedish CArdioPulmonary bioImage Study (SCAPIS).
Outcome Measures:
Aortic augmentation index at heart rate of 75 bpm (Aortic Aix@75), pulse wave velocity, ABI, AGE, HbA1c and anthropometry.
Results:
The participants had significantly higher measures of Aortic Aix@75 (mean 35 vs 21, P = 0.004) and AGE (mean 2.6 vs 2.1, P < 0.001), and lower ABI (mean 1.07 vs 1.26, P < 0.001) and HbA1c (mean 36 vs 37, P = 0.007) than the controls. An abnormal HbA1c level (<31 or >46) was present in eight (32%) and 23 (9%) of the participants with SCI and controls, respectively (P = 0.003). Pulse wave velocity was similar between participants with SCI and controls (mean 8.6 m/s vs 8.5 m/s, P = 0.53).
Conclusions:
The difference in cardiometabolic factors between middle-aged people with long-term cervical and upper thoracic SCI and the general population implies that their cardiometabolic health is compromised. Further studies are needed to determine the prognostic significance of these differences.Trial registration: ClinicalTrials.gov identifier: NCT03515122.
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