Screening, Diagnosis, and Treatment of Cardiometabolic Risk in Persons With Spinal Cord Injury/Disease: A Scoping Review.

OBJECTIVES: To map and categorize evidence related to cardiometabolic disease (CMD) risk in persons with spinal cord injury/disease (SCI/D) and to assess the proportion of studies reporting on sociodemographic variables. DATA SOURCES: A scoping review of scientific evidence was conducted. MEDLINE, CINAHL, and EMBASE databases were searched using primary constructs (SCI/D, CMD) from inception to July 1, 2024. STUDY SELECTION: Articles must meet the following criteria: (1) full-length article, (2) available in English, (3) SCI/D population aged ≥18 years, and (4) diagnosed CMD and/or evaluated CMD strategies/interventions. DATA EXTRACTION: The following information was extracted from the included articles: title, country in which the study was conducted, participant characteristics, sociodemographic variables reported, objective/purpose statement, study design, study type, intervention type, CMD risk factors evaluated, assessment time point(s), additional non-CMD outcome measures, use of clinical practice guidelines for risk stratification, summary of results, and report of clinical implications. DATA SYNTHESIS: Of the 1726 studies screened, 120 met the inclusion criteria. Definitions from the Users' Guide to the Medical Literature were used to categorize studies under Diagnosis (n=75; 62.5%), Therapy (n=27; 22.5%), Prognosis (n=14; 11.7%), and Harm (n=4; 3.3%). Diagnosis studies commonly assessed the presence/absence of CMD using screening tools or biomarkers, although only 25 (20.7%) reported on sociodemographic variables, of which race (24.0%), ethnicity (17.3%), and education (13.3%) were most frequently reported. Positive findings for reducing the risk of obesity, hypertension, dyslipidemia, and diabetes mellitus were found across Therapy studies. Most (85.2%) incorporated health-promoting behaviors such as physical activity, nutritional counseling, and behavior change interventions. Four studies (14.8%) evaluated different pharmacologic treatments (atorvastatin, fenofibrate, α-lipoic acid, semaglutide) to target CMD risk factors. CONCLUSIONS: Most of the literature on CMD in persons with SCI/D pertains to Diagnosis, reinforcing the increased prevalence and risk compared with the general population. Physical activity was the most studied therapeutic intervention to manage CMD after SCI/D; however, the limited number of therapy studies demonstrates a need to explore the efficacy of tailored interventions and multipronged approaches. Sociodemographic reporting was poor across all study types, highlighting a gap in understanding subgroup risk. Future research should prioritize addressing these gaps to improve CMD care.