Actionable Nuggets for SCI (2nd ed., 2013)
Screen for cardiovascular risk factors at least annually.
The Problem:
Cardiovascular disease (CVD) is the leading cause of death among people with SCI. As part of a pattern of premature aging, cardiovascular disease has an earlier onset with SCI. Symptoms of CVD are prevalent in 30-50% of the SCI population. Asymptomatic CVD (due to impaired sensation) may be prevalent in 60-70% of people with chronic 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, and 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. Results may be used to calculate the Framingham Risk Score, an estimate of the 10-year risk for developing CVD, although this 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.
| Desirable | Borderline high risk | High risk | Very high risk | |
|---|---|---|---|---|
| Total cholesterol | < 5.2 | 5.2 – 6.2 | > 6.2 | |
| Low-density lipoprotein (LDL) | < 3.3 | 3.4 – 4.1 | 4.1 – 4.9 | > 4.9 |
| High-density lipoprotein (HDL) | > 1.5 | 1.0 – 1.3 (men) 1.3 – 1.5 (women) | < 1.0 (men) < 1.3 (women) | |
| Triglycerides | < 1.7 | 1.7 – 2.2 | 2.3 – 5.6 | > 5.6 |
Key reference:
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.
Additional references:
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Bauman, W.A., et al. (1994). Cardiac stress testing with thallium-201 imaging reveals silent ischemia in individuals with paraplegia. Archives of Physical Medicine & Rehabilitation, 75(9): 946-50. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=8085927
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The 2010 Canadian Hypertension Education Program recommendations for the management of hypertension. 2010 [cited 2010 April 28, 2010]. http://hypertension.ca/chep.
Chen, Y., et al. (2006). Obesity intervention in persons with spinal cord injury. Spinal Cord, 44(2): 82-91. http://dx.doi.org/10.1038/sj.sc.3101818
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DeVivo, M.J., Black, K.J., & Stover, S.L. (1993). Causes of death during the first 12 years after spinal cord injury. Archives of Physical Medicine & Rehabilitation, 74(3): 248-54. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=8439250
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Actionable Nuggets for Spinal Cord Injury 