Atherosclerotic cardiovascular risk in paralympic athletes with a locomotor Impairment: beneficial effects of high aerobic fitness and practiced sport.

INTRODUCTION: Atherosclerotic cardiovascular disease (ACVD), the leading cause of morbidity and mortality in individuals (I) with a locomotor impairment (LI), occurs at earlier ages in I-LI than in ambulatory individuals because I-LI, in particular those with a spinal cord injury (SCI), display a higher prevalence of ACVD risk factors (RF) mainly due to their increased sedentary habit. However even in Paralympic Athletes (PA) with a LI (PA-LI) the prevalence of ACVD-RF is very high. We tested the hypotheses that both a high oxygen uptake peak (VO2peak) and different types of practiced sport (skilled sport – SS; power sports – PS; intermittent, aerobic and anaerobic mixed metabolisms, sports – IS; endurance sports – ES) affect ACVD-RF prevalence, which is supposed to be low in PA-LI competing in ES and having high VO2peak. METHODS: Data from a total of 118 male PA (62 PA-SCI and 56 PA with other health conidiations (HC) determining a LI – PA-OHC) were retrospectively evaluated. Thirty-six PA competed in SS, 20 in PS, 42 in IS and 20 in ES. They had been screened through anthropometric and blood pressure (BP) measurements and laboratory blood tests to estimate an ACVD-RF score summing 1 point for each of the following RF: central obesity –OB- (waist circumference ≥102 cm), hypertension –HT- (rest systolic BP ≥ 140 mm Hg and/or diastolic BP ≥ 90 mm Hg), dyslipidemia -DL- (total Cholesterol -TC ≥200 mg·dl-1 or LDL-C ≥130 mg·dl-1 or HDL-C <40mg·dl-1), impaired fasting glucose -IFG (glycemia≥100 mg·dl-1) and subtracting 1 point when serum HDL-C was higher than 60 mg·dl-1. All PA underwent to an incremental cardiopulmonary maximal exercise test to assess VO2peak. RESULTS: Prevalence of HT, TC, LDL-C, low-HDL-C, IFG and OB were equal to 8.1% and 8.9%, 39.3% and 41.2%, 45.2% and 41.1%, 27.9% and 24.3%, 33.9% and 32.1%, 19.4% and 7.1% in PA-SCI and PA-OHC, respectively, being significantly different only the OB prevalence (p=0.046). Based on the ACVD-RF score, 3 ACVD-RF groups were formed: group 1 (RF≤0, N=43, 13 PA competing in ES, 15 in IS, 8 in PS and 7 in SS), group 2 (RF=1, N=43, 6 PA competing in ES, 16 in IS, 8 in PS and 13 in SS), group 3 (RF≥2, N=32, 1 PA competing in ES, 11 in IS, 4 in PS and 16 in SS). Grouping the PA depending on sports and ACVD-RF determined a significant difference (χ2), indeed 65% of PA competing in ES had no ACVD-RF while 30% and 5% were in Group 2 and group 3, respectively, while 6.3% of PA competing in SS were in group 1 and 50% in group 3. VO2peak equal to 36±8.3 ml/kg/min in PA of group 1 was significantly higher than the VO2peak of PA included in group 2, equal to 31±8.9, which was significantly higher than that of the PA of group 3 (25±7.5). CONCLUSION: Prevalence of RF was similar in the 2 groups of HC, with the exception of OB which was more prevalent in PA-SCI. DL had a relevant and dangerous prevalence in PA regardless the HC. Competing in ES and having high levels of VO2peak seems to provide a protective effect against the risk of developing ACVD.