Coronary heart disease in individuals with spinal cord injury: assessment of risk factors

Study design: Discussion document. Objectives/methods: To review the work performed on conditions and disorders that predispose persons with spinal cord injury (SCI) to an increased risk of coronary heart disease (CHD). Results/discussion: Individuals with SCI have an increased prevalence of abnormalities in carbohydrate and lipid metabolism because of immobilization, muscle atrophy and relative adiposity. In those with SCI, an inverse relationship has been reported between serum high-density lipoprotein (HDL) cholesterol values and abdominal circumference, and a direct relationship between serum triglycerides levels and abdominal circumference. Persons with SCI have lower serum HDL cholesterol levels than able-bodied controls. A higher prevalence of insulin resistance and diabetes mellitus, as well as an earlier occurrence of coronary heart disease (CHD), has been reported in persons with SCI than in the general population. Recently, a higher prevalence and greater degree of coronary artery calcification by electron beam computerized tomography has been demonstrated in persons with SCI, even if matched with the able-bodied population for age, gender, ethnicity and conventional risk factors for CHD. Knowledge of relative risk of CHD in persons with SCI is important for appropriate intervention strategies. The conventional risk factors for CHD were determined in veterans with SCI to assign risk to determine target low-density lipoprotein cholesterol levels for therapeutic intervention. Limitations of conventional guidelines when applied to the SCI population should be appreciated. Conventional risk factors for CHD should be identified and treated in individuals with SCI, according to current standards of care.