3. Gestion du risque cardiovasculaire en présence de LM

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

Le problème:Woman sitting in wheelchair

La sédentarité et une prévalence élevée de facteurs de risque de MCV tels que dyslipidémie, diabète de type 2, hypertension et obésité contribuent à un risque élevé de maladie cardiovasculaire (MCV) en présence de LM. L’inactivité et une alimentation inadéquate mènent à l’obésité et au déconditionnement, ce qui limite les activités quotidiennes.

Capsule pour l’action

En présence de LM, gérez le risque CV comme chez un patient ambulatoire à risque élevé.

Pratiques d’excellence fondées sur des preuves:

Le traitement énergique de la dyslipidémie, de l’obésité et du diabète est essentiel pour prévenir une augmentation du risque cardiovasculaire. En présence de LM chronique, la pharmacothérapie du cholestérol devrait être alignée sur les directives visant les patients à risque élevé. Le diabète devrait être traité comme dans la population générale.

On a estimé que 50-75 % des personnes ayant une LM sont obèses, et d’importants déficits nutritionnels ont été observés. Les valeurs seuils de l’indice de masse corporelle (IMC) doivent être ajustées pour tenir compte du changement de composition corporelle lié à la LM. On recommande de déplacer le seuil d’embonpoint à 22 contre 25 pour la population générale). La circonférence de la taille, le rapport taille-hanches et la circonférence du cou se sont avérées des substituts raisonnables de l’IMC, étant donné la difficulté de mesurer précisément le poids et la taille chez un patient en fauteuil roulant.

En présence de LM, les lignes directrices fondées sur des preuves touchant l’activité physique recommandent >20 minutes d’activité aérobie modérée ou vigoureuse, deux fois par semaine, ainsi qu’un entraînement en résistance de tous les groupes musculaires importants, deux fois par semaine. L’activité physique régulière a été associée à une amélioration de la condition physique, du profil lipidique, de l’équilibre glycémique, de la douleur et de la dépression. Plusieurs types d’exercice sont populaires, dont : ergomètre manuel, entraînement et sports en fauteuil roulant, natation, entraînement en résistance et ergométrie sous stimulation électrique. Avant de participer à une activité physique, le patient devrait être informé des risques de blessure par surentraînement (voir capsule no 7 : Gestion de la douleur musculosquelettique), d’hyperréflexie autonome et de perturbation de l’homéostasie thermique (voir capsule no 4 : Hyperréflexie autonome).

Source clé:

    Myers, J. (2009). Cardiovascular disease after SCI: Prevalence, instigators, and risk clusters. Topics in Spinal Cord Injury Rehabilitation, 14(3): 1-14.

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