[Apparelyzed]

Spinal Cord Injury May Not Increase Risk of Heart Disease

Objectives: To assess the prevalence of carbohydrate and lipid disorders in adults with chronic spinal cord injury and evaluate their risk contribution to cardiovascular diseases and the potential impact of exercise and pharmacologic and dietary therapies to alter these disorders and reduce cardiovascular disease risk.

Data Sources: MEDLINE® (PubMed®), Cochrane Database and websites of the American Spinal Injury Association, American Paraplegia Society, Paralyzed Veterans of America, Consortium of Spinal Cord Medicine, and WorldCat through August 2007.

Review Methods: English language observational studies addressing prevalence of carbohydrate and lipid disorders were included if they evaluated at least 100 adults with chronic spinal cord injury or a total of 100 subjects if using a control group. Epidemiologic investigations of more than 50 adults with spinal cord injury that were published in English after 1990 and reported cardiovascular morbidity and mortality were abstracted. Intervention studies from 1996-2007 were included regardless of design or size if they assessed exercise, diet, or pharmacologic therapies and reported carbohydrate, lipid, or cardiovascular outcomes.

Results: The quality of evidence regarding the prevalence, impact, and outcomes of carbohydrate and lipid disorders in adults with chronic spinal cord injuries is weak. Evidence is limited by relatively few studies, small sample size, lack of appropriate control groups, failure to adjust for known confounding variables, and variation in reported outcomes. However, the existing evidence does not indicate that adults with spinal cord injuries are at markedly greater risk for carbohydrate and lipid disorders or subsequent cardiovascular morbidity and mortality than able-bodied adults. Body mass index is not reliable for assessing body composition, especially percent body fat, in adults with spinal cord injury. There are no high quality studies evaluating the impact of exercise, diet, or pharmacologic therapies on these disorders.

Conclusions: The available evidence does not support incorporating SCI status as an independent variable to assess risk of cardiovascular morbidity and mortality or to alter diagnostic/treatment thresholds compared to able-bodied adults. Furthermore, individuals with SCI may have unique physiologic differences compared to able-bodied individuals. As a result, it is uncertain that findings from studies conducted in able-bodied adults evaluating efficacy and harms of interventions to improve carbohydrate, lipid disorders, and subsequent CVD can be extrapolated to individuals with SCI. The role of exercise in individuals with spinal cord injuries represents a unique challenge and requires further exploration into the benefits, harms, and resource implications of broad-based spinal cord injury exercise programs.

Source: http://www.ahrq.gov/...p/carbliptp.htm

[kewlcatkez]

Hi Simon,

Quote

impact, and outcomes of carbohydrate and lipid disorders in adults with chronic spinal cord injuries is weak

This may be the case, although its worth bearing in mind that CHD is one of the major killers in most developed or so called 'advanced' countries. Therefore, even if the risks are equal to that of non SCI/D people, there is still a considerable risk to people who have hereditary components (outside of lipid disorders), inactive lifestyles and who have 'lifestyle' factors ( drinking, smoking, eating crap).

As someone who specialised in Cardiology, I just fear that people who may not have/or may not be presented with the whole facts, may very well think that the risk of heart disease in SCI is removed...when in fact, like the rest of the population there are still risks....given the 'wrong' circumstances..

As the paper points out, more research into the outcomes are needed, and therefore you can't count your chickens til they have hatched so to speak.. It is good to hear that potentially SCi/D doesn't *by itself* cause increased risk of IHD.

Thanks for posting this Simon,

Take care,

K