Cardiovascular Disease Risk in Individuals with Complex and Disabling Health Conditions: A Systematic Review and Meta-analysis

Abstract Aim To quantify cardiovascular disease (CVD) risk among individuals with multiple sclerosis (MS), spinal cord injury (SCI), traumatic brain injury (TBI), cerebral palsy (CP), poliomyelitis, or spina bifida, and examine the roles of traditional risk factors and condition-specific characteristics. Methods We systematically searched Embase, MEDLINE, and Web of Science from inception to March 2025. Two reviewers independently screened studies, extracted data, and assessed risk of bias. Random-effects meta-analyses were conducted, and heterogeneity, publication bias, and study quality were evaluated. Sex was considered according to SAGER guidelines. Results Thirty-eight studies involving over 1.6 million individuals were included. Individuals with disabling conditions had higher CVD risk estimates than the general population (IRR = 1.80; HR = 1.83; OR = 2.21). Substantial between-study heterogeneity was observed. MS and SCI were associated with increased risks of stroke, myocardial infarction, and heart failure, while TBI was particularly associated with stroke. Traditional risk factors, including age, sex, diabetes, dyslipidemia, and hypertension, and condition-specific characteristics, including injury severity and recurrence in TBI, injury level in SCI, disease severity in MS, and non-traumatic fractures in CP, were associated with CVD risk or variation in risk estimates. Evidence for some conditions was limited. Conclusions Individuals with disabling conditions had higher CVD risk estimates than the general population, although substantial heterogeneity warrants cautious interpretation. Further research is needed to determine whether tailored cardiovascular risk assessment and preventive strategies improve outcomes.