Association of Cardiovascular Risk Burden with Cardiorespiratory Fitness and Functional Performance in Patients with Post-Stroke Spasticity: A Retrospective Observational Study

Background: Post-stroke spasticity (PSS) is a frequent and disabling complication of stroke that adversely affects mobility, exercise capacity, and functional independence. Although cardiovascular comorbidities are common in this population, their independent associations with cardiorespiratory and functional outcomes remain insufficiently characterized. This study aimed to describe the cardiovascular risk profile of patients with PSS and identify factors independently associated with cardiorespiratory and functional performance. Methods: This retrospective observational study included 117 patients with persistent PSS evaluated at least 3 months after stroke onset. Cardiorespiratory performance was assessed using cardiopulmonary exercise testing (CPET), while functional outcomes were evaluated using the 10-m walk test (10MWT), Barthel Index (BI), and Modified Rankin Scale (mRS). Multivariable linear regression analyses were performed to identify factors independently associated with each outcome. Results: Cardiovascular comorbidities were highly prevalent, particularly arterial hypertension (83.8%), dyslipidemia (59.8%), diabetes mellitus (35.9%), and coronary artery disease (29.1%). Estimated glomerular filtration rate (eGFR) showed the strongest and most consistent independent relationships with the evaluated outcomes, being associated with better cardiorespiratory performance, higher BI scores, and shorter 10MWT completion time. Active smoking, elevated HbA1c, coronary artery disease, and increased C-reactive protein were independently associated with poorer cardiorespiratory and functional performance. No significant associations were observed between cardiovascular risk factors and mRS. Conclusions: Cardiovascular, metabolic, inflammatory, and renal factors are independently associated with cardiorespiratory and functional outcomes in patients with PSS. Renal function showed the most consistent independent associations, while poor glycemic control, active smoking, coronary artery disease, and systemic inflammation were also independently associated with poorer cardiorespiratory and functional outcomes. These findings support systematic cardiovascular risk assessment to facilitate individualized risk stratification and optimize post-stroke rehabilitation.