2. Dépistage du risque cardiovasculaire en présence de LM

Capsules pour l’action (2nd ed., 2013)

Le problème:Woman hand on wheelchair

En présence de LM, la maladie cardiovasculaire (MCV) est la première cause de décès. Composante d’un tableau de vieillissement prématuré, la MCV survient plus tôt en présence de LM. Les symptômes de MCV sont présents chez 30-50 % des personnes ayant une LM. La MCV asymptomatique (en raison de déficits sensitifs) peut toucher 60 70 % des personnes ayant une LM chronique.

Capsule pour l’action

Dépistez au moins annuellement les facteurs de risque cardiovasculaire.

Pratiques d’excellence fondées sur des preuves:

De nombreux facteurs de risque majeurs de la MCV sont aggravés par les LM, dont : dyslipidémie, anomalies de la tension artérielle, contrôle glycémique anormal, inflammation chronique, dysfonctionnement autonome, obésité et sédentarité. Un dépistage vigoureux et une prise en charge préventive peuvent aider à éviter qu’un diagnostic sous-optimal et un traitement conservateur ne contribuent à accroître l’incapacité.

La tension artérielle devrait être mesurée à chaque visite, et au moins une fois par année. Il faut mesurer les lipides et l’hémoglobine A1C chaque année chez les hommes de plus de 40 ans et chez les femmes ménopausées ou de 50 ans et plus. Les résultats permettent de calculer l’indice de Framingham, qui estime le risque de MCV sur 10 ans mais, en présence de LM, cet indice peut sous-estimer le risque de MCV. On recommande donc d’utiliser le protocole III de traitement des adultes du « National Cholesterol Education Program », comme classification plus exacte des taux lipidiques en présence de LM.

Souhaité Risque élevé limite Risque élevé Risque très élevé
Choléstérol total < 5.2 5.2 – 6.2 > 6.2
Lipoprotéines à faible densité (LDL) < 3.3 3.4 – 4.1 4.1 – 4.9 > 4.9
Lipoprotéines à haute densité (LHD) > 1.5 1.0 – 1.3 (hommes)
1.3 – 1.5 (femmes)
< 1.0 (hommes)
< 1.3 (femmes)
Triglycérides < 1.7 1.7 – 2.2 2.3 – 5.6 > 5.6

Source clé:

    Dyson-Hudson, T.A., & Nash, M.S. (2009). Guideline-driven assessment of cardiovascular disease and related risks after spinal cord injury. Topics in Spinal Cord Injury Rehabilitation, 14(3): 32-45.

Références supplémentaires:

    Ayas, N.T., Garshick, E., Lieberman, S.L., Wien, M.F., Tun, C., & Brown, R. (1999). Breathlessness in spinal cord injury depends on injury level. Journal of Spinal Cord Medicine, 22(2): 97-101.
    Bauman, W.A., et al. (1993). Tomographic thallium-201 myocardial perfusion imaging after intravenous dipyridamole in asymptomatic subjects with quadriplegia. Archives of Physical Medicine & Rehabilitation, 74(7): 740-4. http://dx.doi.org/10.1016/0003-9993(93)90036-A
    Bauman, W.A., et al. (1994). Cardiac stress testing with thallium-201 imaging reveals silent ischemia in individuals with paraplegia. Archives of Physical Medicine & Rehabilitation, 75(9): 946-50. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=8085927
    Bauman, W.A., et al. (1998). The effect of residual neurological deficit on serum lipoproteins in individuals with chronic spinal cord injury. Spinal Cord, 36(1): 13-7.
http://dx.doi.org/10.1038/sj.sc.3100513
    Bauman, W.A., & Spungen, A.M. (1994). Disorders of carbohydrate and lipid metabolism in veterans with paraplegia or quadriplegia: a model of premature aging. Metabolism, 43(6): 749-56. http://dx.doi.org/10.1016/0026-0495(94)90126-0
    Buchholz, A.C., Martin Ginis, K.A., Bray, S.R., Craven, B.C., Hicks, A.L., Hayes, K.C., Latimer, A.E. et al. (2009). Greater daily leisure time physical activity is associated with lower chronic disease risk in adults with spinal cord injury. Applied Physiology, Nutrition and Metabolism, 34(4): 640-7.
    Canadian Diabetes Association (2008). Clinical practice guidelines for the prevention and management of diabetes in Canada. Canadian Journal of Diabetes, 32(Suppl 1): S1-S201.
http://www.diabetes.ca/for-professionals/resources/2008-cpg/
    Canadian Task Force on Preventative Health Care (2012). Recommendations on screening for type 2 diabetes in adults. Canadian Medical Association Journal, 184(15):1687-96.
    The 2010 Canadian Hypertension Education Program recommendations for the management of hypertension. 2010 [cited 2010 April 28, 2010]. http://hypertension.ca/chep.
    Chen, Y., et al. (2006). Obesity intervention in persons with spinal cord injury. Spinal Cord, 44(2): 82-91. http://dx.doi.org/10.1038/sj.sc.3101818
    Chilibeck, P.D., et al. (1999). Functional electrical stimulation exercise increases GLUT-1 and GLUT-4 in paralyzed skeletal muscle. Metabolism, 48(11): 1409-13.
http://dx.doi.org/10.1016/S0026-0495(99)90151-8
    D’Agostino, R.B., Sr., et al. (2008). General cardiovascular risk profile for use in primary care: the Framingham Heart Study. Circulation, 117(6): 743-53.
http://dx.doi.org/10.1161/CIRCULATIONAHA.107.699579
    de Groot, P.C., et al. (2003). Effect of training intensity on physical capacity, lipid profile and insulin sensitivity in early rehabilitation of spinal cord injured individuals. Spinal Cord, 41(12): 673-9. http://dx.doi.org/10.1038/sj.sc.3101534
    DeVivo, M.J., Black, K.J., & Stover, S.L. (1993). Causes of death during the first 12 years after spinal cord injury. Archives of Physical Medicine & Rehabilitation, 74(3): 248-54.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=8439250
    Eichler, K., et al. (2007). Prediction of first coronary events with the Framingham score: a systematic review. American Heart Journal, 153(5): 722-31, 731 e1-8.
http://dx.doi.org/10.1016/j.ahj.2007.02.027
    El-Sayed, M.S., & Younesian, A. (2005). Lipid profiles are influenced by arm cranking exercise and training in individuals with spinal cord injury. Spinal Cord, 43(5): 299-305.
http://dx.doi.org/10.1038/sj.sc.3101698
   Elder, C.P., Apple, D.F., Bickel, C.S., Meyer, R.A., & Dudley, G.A. (2004). Intramuscular fat and glucose tolerance after spinal cord injury-a cross-sectional study. Spinal Cord, 42(12):711-6.
    Finnie, A.K., Buchholz, A., & Martin Ginis, K.A.; SHAPE-SCI Research Group (2008). Current coronary heart disease risk assessment tools may underestimate risk in community-dwelling persons with chronic spinal cord injury. Spinal Cord, 46(9): 608-15.
    Garshick, E., et al. (2005). A prospective assessment of mortality in chronic spinal cord injury. Spinal Cord, 43(7): 408-16. http://dx.doi.org/10.1038/sj.sc.3101729
    Genest, J., et al. (2009). Canadian Cardiovascular Society/Canadian guidelines for the diagnosis and treatment of dyslipidemia and prevention of cardiovascular disease in the adult – 2009 recommendations. Canadian Journal of Cardiology, 25(10): 567-79.
http://www.pulsus.com/journals/abstract.jsp?sCurrPg=abstract&jnlKy=1&atlKy=9081&isuKy=877&isArt=t&fromfold=
    Gibson, A.E., Bushholz, A.C., & Martin Ginis, K.A.; SHAPE-SCI Research Group (2008). C-Reactive protein in adults with chronic spinal cord injury: Increased chronic inflammation in tetraplegia vs paraplegia. Spinal Cord, 46(9): 616-21.
    Groah, S.L., Nash, M.S., Ward, E.A., Libin, A., Mendez, A.J., Burns, P., Elrod, M., et al. (2011). Cardiometabolic risk in community-dwelling persons with chronic spinal cord injury. Journal of Cardiopulmonary Rehabilitation and Prevention, 31(2): 73-80.
    Hetz, S.P., Latimer, A.E., Buchholz, A.C., & Martin Ginis, K.A.; SHAPE-SCI Research Group (2009). Increased participation in activities of daily living is associated with lower cholesterol levels in people with spinal cord injury. Archives of Physical Medicine and Rehabilitation, 90(10): 1755-9.
    Jeon, J.Y., et al. (2002). Improved glucose tolerance and insulin sensitivity after electrical stimulation-assisted cycling in people with spinal cord injury. Spinal Cord, 40(3): 110-7.
http://dx.doi.org/10.1038/sj.sc.3101260
    LaVela, S.L., et al. (2006). Diabetes mellitus in individuals with spinal cord injury or disorder. Journal of Spinal Cord Medicine, 29(4): 387-395. http://www.ncbi.nlm.nih.gov/pubmed/17044389
    LaVela, S.L., Evans, C.T., Prohashka, T.R., Miskevics, S., Ganesh, S.P., & Weaver, F.M. (2012). Males aging with a spinal cord injury: Prevalence of cardiovascular and metabolic conditions. Archives of Physical Medicine and Rehabilitation, 93(1): 90-5.
   Lee, C.S., et al. (2006). Evaluating the prevalence of silent coronary artery disease in asymptomatic patients with spinal cord injury. International Heart Journal, 47(3): 325-330.
http://dx.doi.org/10.1536/ihj.47.325
   Mohr, T., et al. (2001). Insulin action and long-term electrically induced training in individuals with spinal cord injuries. Medicine and Science in Sports and Exercise, 33(8): 1247-52. http://dx.doi.org/10.1097/00005768-200108000-00001
    Myers, J. (2009). Cardiovascular disease after SCI: Prevalence, instigators, and risk clusters. Topics in Spinal Cord Injury Rehabilitation, 14(3): 1-14.
    Nash, M.S., et al. (2001). Circuit resistance training improves the atherogenic lipid profiles of persons with chronic paraplegia. Journal of Spinal Cord Medicine, 24(1): 2-9.
http://www.ncbi.nlm.nih.gov/pubmed/11587430
    Nash, M.S., & Mendez, A.J. (2007). A guideline-driven assessment of need for cardiovascular disease risk intervention in persons with chronic paraplegia. Archives of Physical Medicine & Rehabilitation, 88(6): 751-7. http://dx.doi.org/10.1016/j.apmr.2007.02.031
    Ozgurtas, T., et al. (2003). Do spinal cord injuries adversely affect serum lipoprotein profiles? Military Medicine, 168(7): 545-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=12901464
    Ragnarsson, K.T. (2012). Medical rehabilitation of people with spinal cord injury during 40 years of academic practice. American Journal of Physical Medicine and Rehabilitation, 91(3): 231-42.
    Shah, P.K., Stevens, J.E., Gregory, C.M., Pathare, N.C., Jayaraman, A., Bickel, S.C., Bowden, M., et al. (2006). Lower-extremity muscle cross-sectional area after incomplete spinal cord injury. Archives of Physical Medicine & Rehabilitation, 87(6):772-8.
    Solomonow, M., et al. (1997). Reciprocating gait orthosis powered with electrical muscle stimulation (RGO II). Part II: Medical evaluation of 70 paraplegic patients. Orthopedics, 20(5): 411-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=9172248
    Spungen, A.M., et al. (2003). Factors influencing body composition in persons with spinal cord injury: a cross-sectional study. Journal of Applied Physiology, 95(6): 2398-407.
http://jap.physiology.org/cgi/content/abstract/95/6/2398
    Stewart, B.G., et al. (2004). Treadmill training-induced adaptations in muscle phenotype in persons with incomplete spinal cord injury. Muscle & Nerve, 30(1): 61-8.
http://dx.doi.org/10.1002/mus.20048
    Svircev, J.N. (2009). Cardiovascular disease in persons with spinal cord dysfunction-An update on select topics. Physical Medicine and Rehabilitation Clinics of North America, 20(4): 737-747.
    Szlachcic, Y., et al. (2001). The effect of dietary intervention on lipid profiles in individuals with spinal cord injury. Journal of Spinal Cord Medicine, 24(1): 26-29.
http://www.ncbi.nlm.nih.gov/pubmed/11587431
    Teasell, R.W., Hsieh, J.T., Aubut, J.A.L., Eng, J.J., Krassioukov, A., & Tu., L. (2010). Venous thromboembolism after spinal cord injury. Archives of Physical Medicine and Rehabilitation, 90(92): 193-200).
    Waddimba, A.C., Jain, N.B., Stolzmann, K. Gagnon, D.R., Burgess, J.F., Jr., Kazis, L.E., et al. (2009). Predictors of cardiopulmonary hospitalization in chronic spinal cord injury. Archives of Physical Medicine and Rehabilitation, 90(2): 193-200.
    Wahman, K., et al. (2010). Cardiovascular disease risk factors in persons with paraplegia: the Stockholm spinal cord injury study. Journal of Rehabilitation Medicine, 42(3): 272-8.
http://dx.doi.org/10.2340/16501977-0510
    Wahman, K., Nash, M.S., Lewis, J.E., Seiger, A., & Levi, R. (2011). Cardiovascular disease risk and the need for prevention after paraplegia determined by conventional multifactorial risk models: The Stockholm spinal cord injury study. Rehabilitation Medicine, 43(3): 237-242.