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Adults with cerebral palsy have doubled CVD and respiratory risk

Adults with cerebral palsy are about twice as likely to develop cardiovascular disease and chronic respiratory disease compared to adults without cerebral palsy, according to a study led by RCSI (Royal College of Surgeons in Ireland) and Brunel University London. The study compared 1,700 adults with cerebral palsy and 5,000 adults without cerebral palsy to identify how many developed non-infectious diseases, such as asthma or stroke.

Patients with cerebral palsy were overall 75% more likely to have a non-communicable disease. After adjusting for other variables, the study found that adults with cerebral palsy were around twice as likely to develop cardiovascular disease and chronic respiratory disease, such as asthma, but not more likely to develop diabetes or cancer.

Adults with cerebral palsy were specifically 2.6 times more likely to develop heart failure, 5.5 times more likely to have a stroke, 2.2 times more likely to develop asthma, 1.6 times more likely to develop hypertension and 2.3 times more likely to develop ischaemic heart disease.

Globally, approximately 17m people have cerebral palsy. Although cerebral palsy was historically considered a paediatric condition, the majority of children with cerebral palsy now survive into adulthood and many adults with cerebral palsy have a near normal life expectancy.

Cerebral palsy is not a progressive condition. However, at least a quarter of young adults report that their ability to walk gets worse, which may contribute to the development of chronic health conditions.

"Until recently, we did not know much about the consequences of ageing with cerebral palsy. Our findings highlight the need for further research into the management of non-communicable diseases in this population," said Jennifer Ryan, the study's lead author and StAR research lecturer at RCSI and senior lecturer at Brunel University London.

"Recent clinical guidelines for adults with cerebral palsy in the UK recommended that pathways need to be developed that allow adults with cerebral palsy access to a multidisciplinary team. However, adults with cerebral palsy in Ireland lack access to co-ordinated multidisciplinary support."

Being able to access health professionals, such as physiotherapists, orthopaedic surgeons and neurologists with knowledge of cerebral palsy early, may slow deterioration in the patient's function and prevent development of secondary conditions with age.

Dr Neil O'Connell, co-author, physiotherapist and senior lecturer at Brunel University London said: "Our results clearly emphasise the importance of reframing how cerebral palsy is traditionally viewed; to recognise that it is not simply a condition of childhood. Health services should be designed and delivered with the aim of supporting people with cerebral palsy to be healthy and active throughout their lives."

The study was funded by the Brunel University London Research Catalyst Fund, and it involved collaborators from Brunel University London, University of Michigan-Medicine, London School of Hygiene and Tropical Medicine, Aberdeen Royal Infirmary, Hospital Clinico San Carlos, University of Surrey and Queen Mary University London.

Abstract
Objective: To compare the incidence of noncommunicable diseases between adults with and without cerebral palsy (CP).
Methods: A cohort study was conducted using primary care data from the Clinical Practice Research Datalink. Cox models, stratified by matched set and adjusted for potential confounders, were fitted to compare the risk of any noncommunicable disease, cancer, cardiovascular disease, type 2 diabetes mellitus, and respiratory disease between adults with and without CP.
Results: The analysis included 1,705 adults with CP and 5,115 age-, sex-, and general practice–matched adults without CP. There was evidence from adjusted analyses that adults with CP had 75% increased risk of developing any noncommunicable disease compared to adults without CP (hazard ratio [HR] 1.75, 95% confidence interval [CI] 1.58–1.94). Specifically, they had increased risk of cardiovascular disease (HR 1.76, 95% CI 1.48–2.11) and respiratory disease (HR 2.61, 95% CI 2.14–3.19). There was no evidence of increased risk of cancer or type 2 diabetes mellitus.
Conclusions: Adults with CP had increased risk of noncommunicable disease, specifically cardiovascular and respiratory disease. These findings highlight the need for clinical vigilance regarding identification of noncommunicable disease in people with CP and further research into the etiology and management of noncommunicable disease in this population.

Authors
Jennifer M Ryan, Mark D Peterson, Anthony Matthews, Nicola Ryan, Kimberley J Smith, Neil E O'Connell, Silvia Liverani, Nana Anokye, Christina Victor, Elizabeth Allen

[link url="https://www.sciencedaily.com/releases/2019/08/190829101104.htm"]RCSI material[/link]
[link url="https://n.neurology.org/content/early/2019/08/28/WNL.0000000000008199"]Neurology abstract[/link]

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