Capsules pour l’action (2nd ed., 2013)
Dépistez au moins annuellement les facteurs de risque cardiovasculaire.
Le problème:
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.
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.
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Actionable Nuggets for Spinal Cord Injury 