Complex and disabling health conditions were associated with a substantially higher risk of cardiovascular disease compared with the general population (HR 1.76).
Meta-Analysis (n=1,600,000)
Do individuals with severe and complex health conditions have a higher risk of cardiovascular disease compared to the general population?
Individuals with severe and complex health conditions, such as MS, SCI, and TBI, have a substantially higher risk of cardiovascular disease compared to the general population, highlighting the need for tailored risk assessment.
Hazard Ratio: 1.76
Abstract Background Cardiovascular disease (CVD) remains the leading cause of morbidity and mortality worldwide. Adults with complex and disabling conditions, such as multiple sclerosis (MS), spinal cord injury (SCI), traumatic brain injury (TBI), cerebral palsy (CP), poliomyelitis, and spina bifida (SB), may face elevated CVD risk due to impaired autonomic regulation, mobility limitations, and metabolic dysfunction. No prior evidence synthesis has comprehensively quantified risk across multiple conditions and major cardiovascular outcomes. Thus, we conducted a systematic review of the literature to evaluate the risk of CVD in individuals with complex and disabling health conditions and explore the key risk factors contributing to disease burden. Methods We searched EMBASE, Web of Science, and MEDLINE from inception until to March 2025. Two reviewers independently screened studies, extracted data, and assessed risk of bias. Random-effects meta-analyses were performed to pool effect estimates, with heterogeneity and publication bias evaluated. Risk of bias was evaluated using the NIH tool. Results Across 38 studies including over 1.6 million individuals with complex and disabling health conditions, pooled analyses indicated higher CVD risk compared with the general population (IRR = 1.80; HR = 1.76; OR = 2.21). MS and SCI consistently showed elevated risks of stroke, MI, and HF, while TBI was particularly associated with stroke. Traditional risk factors include age, sex, race, socioeconomic status, behavior, and comorbidities, which contributed to CVD risk, moreover, disability-specific characteristics, including TBI type and severity, SCI injury level, MS disease severity, CP and SB mobility impairment, polio-related body composition, polytrauma, and prior fractures, were also independent risk factors. Sensitivity analyses confirmed robustness. Quality of evidence was generally good, though limited by heterogeneity and bias. Conclusions Individuals with MS, SCI, TBI, CP, SB, and polio have substantially higher CVD risk. Both traditional and disability-specific factors independently contribute, underscoring the need for tailored cardiovascular risk assessment and prevention.
Xu et al. (Mon,) conducted a meta-analysis in Complex and disabling health conditions (n=1,600,000). Complex and disabling health conditions vs. General population was evaluated on Cardiovascular disease (CVD) (HR 1.76). Complex and disabling health conditions were associated with a substantially higher risk of cardiovascular disease compared with the general population (HR 1.76).