A Provider’s Guide to Vascular Disease, Dyslipidemia, and Glycemic Dysregulation in Chronic Spinal Cord Injury

Top Spinal Cord Inj Rehabil, 2020 · DOI: 10.46292/sci2603-203 · Published: July 1, 2020

Spinal Cord Injury Cardiovascular Science Endocrinology

Simple Explanation

Individuals with chronic SCI are more likely to develop accelerated hardening of the arteries, unhealthy cholesterol levels, and problems with blood sugar control. This article reviews current understandings and recommendations for managing cardiovascular and glycemic issues in people with SCI, highlighting the need for lifestyle changes and regular screening. The authors suggest lifestyle changes ought to be globally encouraged, individuals with clinical vascular disease should be treated, as tolerated, with high intensity statins.

Study Duration

Not specified

Participants

Individuals with chronic spinal cord injury

Evidence Level

Review article

Key Findings

1
People with chronic SCI are at increased risk for atherogenesis and ischemic heart disease.
2
Chronic SCI is typically associated with a particular pattern of dyslipidemia, with normal or low total cholesterol but significantly reduced HDL-C.
3
Recent guidelines suggest that it is equally valid to screen people with SCI for IGT and DM with FPG, OGTT, and HbA1c.

Research Summary

Individuals with chronic spinal cord injury (SCI) are predisposed to accelerated atherogenesis, dyslipidemia, and glycemic dysregulation, although not enough is known about the etiologies or clinical consequences of these secondary effects of paralysis. While guidelines for the detection and treatment of cardiometabolic disease in SCI have recently been published, there has been a historical paucity of data-driven approaches to these conditions. This article will describe what is and not known about the cardiovascular disease and glycemic dysregulation that frequently attend SCI. It will conclude with a review of both guideline-driven and informal recommendations addressing the clinical care of people living with SCI.

Practical Implications

Lifestyle Interventions

Recommend a minimum amount of exercise and suggest foods with lower caloric but high nutrient density.

Dyslipidemia Treatment

Adherence to the 2018 ACC/AHA Multisociety Guidelines on the Management of Blood Cholesterol.

Glycemic Control Screening

Screen people with SCI for disordered glycemic control at least every 3 years using HbA1c.

Study Limitations

1
The cardiometabolic effects of SCI remain greatly understudied
2
No prospective clinical trials demonstrating reductions in morbidity or mortality with treatment of suboptimal lipid levels in individuals with SCI.
3
Traditional cardiovascular risk factors seem to underestimate actual cardiac risk in people with chronic SCI

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