3. Management of Cardiovascular Risk in Patients with SCI

Actionable Nuggets for SCI (2nd ed., 2013)

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

The Problem:

A sedentary lifestyle and a high prevalence of CVD risk factors such as dyslipidemia, type 2 diabetes, hypertension and obesity, place individuals with SCI at high risk for cardiovascular disease (CVD). Physical inactivity and dietary inadequacies result in obesity and profound de-conditioning, leading to activity limitations.

Evidence-based Best Practice:

Aggressive treatment of dyslipidemia, obesity and diabetes are essential to prevent excess cardiovascular disease risk. People with chronic SCI should receive guideline-level pharmacological management of cholesterol for high risk patients. Diabetes should be treated as for the general 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:

   Myers, J. (2009). Cardiovascular disease after SCI: Prevalence, instigators, and risk clusters. Topics in Spinal Cord Injury Rehabilitation14(3): 1-14.

Additional references:

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    Laughton, G.E., Buchholz, A.C., Martin Ginis, K.A., Goy, R.E.; SHAPE Research Group (2009). Lowering body mass index cutoffs better identifies obese persons with spinal cord injury. Spinal Cord47(10): 757-62.
    Liang, H., Tomey, K., Chen, D., Saver, N.L., Rimmer, J.H., Braunscheig, C.L. (2008). Objective measures of neighborhood environment and self-reported physical activity in spinal cord injured men. Archives of Physical Medicine & Rehabilitation89(8): 1468-73.
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