3. Management of Cardiovascular Risk in Patients with SCI

Actionable Nuggets for SCI (3rd ed., 2016)

The Problem:Woman sitting in wheelchair

Forced immobility due to paralysis can result in obesity and profound de-conditioning, placing people with SCI at high risk for cardiovascular disease (CVD).  In addition, SCI predisposes individuals to dyslipidemia, type 2 diabetes and hypertension.  Recent studies suggest that cognitive deficits may result from hypotension (lesions above T1) and arterial stiffness (lesions below T7).  This may be due to altered sympathetic tone related to the level of lesion.

Actionable Nugget

Manage cardiovascular risk among patients with SCI as you would a high-risk ambulatory patient.

Evidence-based Best Practice:

Aggressive treatment of dyslipidemia, obesity and diabetes are essential to minimize risk for cardiovascular disease. People with chronic SCI should receive pharmacological, dietary and lifestyle management of hyperlipidemia, hypertension and Type II diabetes, as you would for high risk patients in the ambulatory population.

Obesity has been estimated at 50-75% in the SCI population, and significant nutritional inadequacies have been found. Body mass index (BMI) cut-off scores must be adjusted to account for altered body composition with SCI. A cut-off of 22 is recommended (vs. 25 for the general population). Measures of waist circumference, waist-hip ratio and neck circumference have been shown to be a reasonable substitute for BMI, given difficulties in obtaining accurate weight and height measurements among wheelchair users.

Evidence-based physical activity guidelines for the SCI population recommend >20 minutes of moderate to vigorous aerobic activity twice a week, and resisted strength training twice a week for all major muscle groups. Regular physical activity has been associated with improved physical fitness, lipid profiles, glucose homeostasis, and reduced pain and depression. Popular modes of exercise include arm ergometry, wheelchair propulsion, wheelchair sports, swimming, circuit resistance training and electrically stimulated cycling. Prior to participation in physical activity, patients should be made aware of the potential for overuse injuries (see Nugget #7: Management of Musculoskeletal Pain), autonomic dysreflexia, thermal dysregulation (see Nugget #4: Autonomic Dysreflexia)

Key Reference:

     Cragg, J. J., Stone, J. A., & Krassioukov, A. V. (2012). Management of Cardiovascular Disease Risk Factors in Individuals with Chronic Spinal Cord Injury: An Evidence-Based Review. Journal of Neurotrauma, 29(11), 1999–2012. http://doi.org/10.1089/neu.2012.2313

 Additional References (chronological listing):

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