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J Rehabil Med 2019; 51: 51: 525–531 ORIGINAL REPORT EMERGING EVIDENCE FOR ACCELERATED AGEING AND CARDIOVASCULAR DISEASE IN INDIVIDUALS WITH CEREBRAL PALSY Patrick G. MCPHEE, PhD 1,2,3 , Maureen J. MACDONALD, PhD 4 , Jem L. CHENG, MSc 4 , Emily C. DUNFORD, PhD 4 and Jan Willem GORTER, MD, PhD 1,2,3 From the 1 Department of Pediatrics, McMaster University, 2 School of Rehabilitation Science, McMaster University, 3 CanChild Centre for Childhood Disability Research, Department of Pediatrics, McMaster University, and 4 Department of Kinesiology, McMaster University, Hamilton, ON, Canada Objective: To examine longitudinal changes in tra- ditional and non-traditional risk factors for cardio- vascular disease in individuals with cerebral palsy and to investigate relationships between age, Gross Motor Function Classification System (GMFCS) and risk of cardiovascular disease. Methods: Individuals with cerebral palsy (n  = 28 of 53 eligible participants; GMFCS levels I–V; follow-up mean age 35.1 years (standard deviation (SD) 14.4) participated in a longitudinal cohort study with 4.0 years (SD 1.2) follow-up. Traditional risk factors in- cluded waist circumference and systolic blood pres- sure. Non-traditional risk factors included carotid artery intima media thickness and distensibility, carotid-femoral pulse wave velocity, and flow-med- iated dilation. Results: Absolute (0.31 mm (SD 0.13) vs 0.22 mm (SD 0.08) , p  = 0.045, 95% confidence interval (95% CI) 0.040, 0.151) and relative flow-mediated dilation (9.9 % (SD 4.7) vs 7.5 % (SD 2.6), p  = 0.049, 95% CI 0.464, 4.42) decreased, while carotid artery intima media thickness (0.52 mm (SD 0.17) vs 0.67 mm (SD 0.33), p  = 0.041, 95% CI –0.242, –0.074) increased from baseline to follow-up. No other risk factor chan- ged significantly. Age at baseline was a significant independent predictor of carotid artery intima media thickness change (R-squared  = 0.261, p  = 0.031). Conclusion: Individuals with cerebral palsy experience significant changes in non-traditional risk factors for cardiovascular disease over 4 years, in the face of no changes in traditional risk factors. Compared with fin- dings in the literature from the general population, these risk factors progress at a faster rate and at a younger age in individuals with cerebral palsy. Key words: cerebral palsy; cardiovascular disease; risk fac- tor, endothelial function; arterial stiffness. Accepted May 10, 2019; Epub ahead of print May 23, 2019 J Rehabil Med 2019; 51: 525–531 Correspondence address: Patrick G. McPhee, CanChild Centre for Childhood Disability Research, IAHS 408, McMaster University, 1400 Main Street West, Hamilton, Ontario L8S 1C7, Canada. E-mail: mcp- [email protected] C erebral palsy (CP) is the most common child- hood physical disability (1). However, very little is known about the effects of ageing on individuals with CP. It is hypothesized that individuals with CP LAY ABSTRACT Recent research has shown that individuals with cere- bral palsy are at increased risk of developing cardio- vascular disease compared with the general population. However, no studies have investigated the progression of risk of cardiovascular disease in individuals with ce- rebral palsy over time. This study measured risk factors for cardiovascular disease in 28 individuals with cerebral palsy over a 4-year time period. Some risk factors for cardiovascular disease appeared to progress at a fas- ter rate and at a younger age in people with cerebral palsy compared with the general population. It is re- commended that clinicians measure risk factors for car- diovascular disease in this population early on, in order to prevent the development of cardiovascular disease later in life. experience an accelerated ageing process that might be linked to an increased prevalence of secondary conditions, such as reduced range of motion, muscular strength, aerobic endurance and increased fatigue (2, 3). Adults with CP have been reported as overweight and/or obese (4), sedentary (5), engaging in low levels of physical activity (6), and hypertensive (7), all of which contribute to an increased risk of developing cardiovascular disease (CVD) (8). CVD remains the leading cause of death globally, meaning that more people die annually from diseases related to the cardiovascular system than any other cause (9). The World Health Organization (WHO) acknowledged that many CVDs can be prevented by modification of behavioural risk factors, such as un- healthy diet, obesity, and physical inactivity (9). We recently conducted a systematic review that examined the prevalence of CVD, risk factors for CVD, and CVD-related mortality among adults with CP (10). An important finding was that CVD-related deaths were elevated in individuals with CP compared with the general population. However, the development and progression of CVD in this population remains poorly understood. A key limitation was a lack of longitudinal studies, of both ambulatory and non-ambulatory adults with CP investigating overweight/obesity, hyperten- sion, other CVD risk factors and CVD itself. Indeed, Peterson et al. recently examined age-related trends in cardiometabolic disease in adults with CP from a de- This is an open access article under the CC BY-NC license. www.medicaljournals.se/jrm Journal Compilation © 2019 Foundation of Rehabilitation Information. ISSN 1650-1977 doi: 10.2340/16501977-2564