2. Screening for Cardiovascular Risk in SCI

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

Screen for cardiovascular risk factors at least annually.

The Problem:

Cardiovascular disease (CVD) is the leading cause of death among people with SCI. Symptoms of CVD are prevalent in 30-50% of the SCI population, and asymptomatic CVD (due to impaired sensation) may be prevalent in 60-70% of people with chronic SCI.  Cardiovascular disease may be part of a pattern of premature aging, with an earlier onset in patients with SCI.

Evidence-based Best Practice:

A number of key risk factors for CVD are exacerbated by SCI, such as dyslipidemia, blood pressure irregularities, abnormal glycemic control, chronic inflammation, autonomic nervous system dysfunction, obesity, and physical inactivity. Aggressive screening and preventive management are required in order that under-diagnosis and conservative treatment do not add to the burden of disability.

Blood pressure should be measured at every encounter — at least annually. Plasma lipid and hemoglobin A1C profiles should be assessed annually in men after 40 years of age, and in women who are at least 50 years of age or postmenopausal. The Framingham Risk Score (an estimate of the 10-year risk for developing CVD) may underestimate CVD risk in the SCI population. The National Cholesterol Education Program’s Adult Treatment Protocol III is recommended as a more accurate classification of lipid levels for the SCI population.

 DesirableBorderline high riskHigh riskVery high risk
Total cholesterol< 5.25.2 – 6.2> 6.2 
Low-density lipoprotein (LDL)< 3.33.4 – 4.14.1 – 4.9> 4.9
High-density lipoprotein (HDL)> 1.51.0 – 1.3 (men)
1.3 – 1.5 (women)
< 1.0 (men)
< 1.3 (women)
Triglycerides< 1.71.7 – 2.22.3 – 5.6> 5.6

 Key Reference:

    West, C. R., Mills, P., & Krassioukov, A. V. (2012). Influence of the neurological level of spinal cord injury on cardiovascular outcomes in humans: a meta-analysis. Spinal Cord, 50(7), 484–492. http://doi.org/10.1038/sc.2012.17

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