ACTIONABLE NUGGET:
Screen for cardiovascular risk factors at least annually.
The Problem
Cardiovascular disease (CVD) is a leading cause of death among people with SCI. Risk for CVD is higher than for the general population, and key risk factors for CVD are exacerbated by SCI; specifically, dyslipidemia, blood pressure irregularities, abnormal glycemic control, chronic inflammation, autonomic nervous system dysfunction, obesity, and physical inactivity. Early onset CVD is part of a pattern of premature aging among people with SCI. In many instances, CVD is asymptomatic because of impaired sensation and lack of strenuous activity. Lifetime prevalence is estimated at 30-50%, but may actually be as high as 60-70%, given asymptomatic cases.
Evidence-based Best Practice
Aggressive screening is required in order that under-diagnosis and conservative treatment do not add to the burden of disability.
- Waist circumference > 37” (94 cm) in supine lying is a better indication of obesity than BMI, although at risk BMI has been calibrated at 22/21 for males/females with quadriplegia, and 26/28 with paraplegia.
- Blood pressure should be measured at every encounter. Resting BP should be <140/90 mmHg. Also be aware of fluctuations and potential for autonomic dysreflexia (See Nugget #4).
- The Framingham Risk Score may underestimate CVD risk in the SCI population. The National Cholesterol Education Program’s Adult Treatment Protocol III is recommended as a more accurate classification of lipid levels for the SCI population (see below).
- HDL levels should be <40 mg/dL for men or <50 for women; LDL should be <159.
- Hemoglobin A1C profiles should be assessed annually > 40 years of age for men, or >50 for women.
- Plasma glucose should be >100 mg/dL; 2-hour glucose tolerance should be >200.
| Desirable | Borderline high risk | High risk | Very high risk | |
|---|---|---|---|---|
| Total cholesterol | < 5.2 | 5.2 – 6.2 | > 6.2 | |
| Low-density lipoprotein (LDL) | < 3.3 | 3.4 – 4.1 | 4.1 – 4.9 | > 4.9 |
| High-density lipoprotein (HDL) | > 1.5 | 1.0 – 1.3 (men) 1.3 – 1.5 (women) | <1.0 (men) <1.3 (women) | |
| Triglycerides | < 1.7 | 1.7 – 2.2 | 2.3 – 5.6 | > 5.6 |
Key Reference
Yarar-Fisher, C.,, Heyn, P., Zanca, J. M., Charlifue, S., Hsieh, J. & Brienza, D. M. (2016). Early identification of cardiovascular diseases in people with spinal cord injury: Key information for primary care providers. Archives of Physical Medicine and Rehabilitation, 98(6), 1277-1279. doi:10.1016/j.apmr.2016.10.001
Actionable Nuggets (4th ed., 2019)
Additional References (since 2016)
Adriaansen, J. J. E., Douma-Haan, Y., van Asbeck, Floris W. A, van Koppenhagen, C. F., de Groot, S., Smit, C. A., . . . ALLRISC. (2017). Prevalence of hypertension and associated risk factors in people with long-term spinal cord injury living in the netherlands.Disability and Rehabilitation, 39(9), 919-927. doi:10.3109/09638288.2016.1172349
Aidinoff, E., Bluvshtein, V., Bierman, U., Gelernter, I., Front, L., & Catz, A. (2017). Coronary artery disease and hypertension in a non-selected spinal cord injury patient population.Spinal Cord, 55(3), 321-326. doi:10.1038/sc.2016.109
Köseoğlu, B. F., Safer, V. B., Öken, Ö., & Akselim, S. (2017). Cardiovascular disease risk in people with spinal cord injury: Is there a possible association between reduced lung function and increased risk of diabetes and hypertension?Spinal Cord, 55(1), 87-93. doi:10.1038/sc.2016.101
Actionable Nuggets for Spinal Cord Injury 