A spinal cord injury often leads to other complications and challenges, such as a greater risk of developing cardiovascular diseases. Fortunately these risks can be managed
People with spinal cord injuries (SCIs) are more likely to suffer from cardiovascular diseases than non-injured peers. This group of conditions further places them at a greater risk of morbidity and mortality from cardiovascular incidents such as strokes or heart attacks. To reduce these risks, a person with an SCI needs careful lifelong follow-up.
Why the elevated risk?
So how come people with SCIs are at an elevated risk of cardiovascular disease? There are many contributing factors, of which several are modifiable through lifestyle changes. Some of the risk factors facing people with SCI include:
• Alterations in cholesterol metabolism
Cholesterol is a fatty substance produced in the liver and found in some food. There are two types: high-density lipoprotein (HDL) cholesterol, or “good cholesterol”; and low-density lipoprotein (LDL), or “bad cholesterol”, which can clog the arteries.
For reasons unclear to scientists, the liver’s ability to properly metabolise cholesterol is altered after an SCI. Therefore people with SCIs are prone to higher levels of LDL. They should have their cholesterol levels checked from their mid-20s. These readings can be used to calculate the risk of heart diseases.
Daily exercise can reduce LDL and boost HDL, but is not always possible for people with SCIs. That is why it is important to manage cholesterol levels through diet. Failing that, medication might be required.
• Elevated C-reactive protein (CRP)
This protein is produced by the liver in response to inflammation. Elevated levels increase the risk of generalised cardiovascular diseases. Generally, CRP levels are higher in people with SCIs because of urinary tract infections, pressure sores, infections or inflammation.
• Obesity and visceral adipose tissue
There is a higher prevalence of obesity and greater visceral adipose tissue among people with SCIs. This is mainly due to high levels of inactivity. Gaining weight is easy, but loosing excess weight is difficult and worsened by some medications that increase appetite and cause weight gain.
• Diabetes, blood pressure and heart arrhythmias
SCIs are associated with a higher risk of insulin resistance, diabetes and metabolic syndrome, which directly relates to inactivity and increased visceral fat. Blood pressure abnormalities such as orthostatic hypotension and autonomic dysreflexia are common in both acute and chronic SCI patients.
Deep vein thrombosis and thromboembolic events often occur with acute and chronic phase SCI, while heart arrhythmias found particularly in acute phase SCI make patients more vulnerable to cardiovascular events. Studies suggest an increased rate of smoking – a big risk factors for cardiovascular diseases – among SCI patients.
To help manage all of these risks, people with SCIs should go for annual check-ups that include discussing the above concerns. Lifestyle and dietary changes, and/or medication might be necessary.
Dr Ed Baalbergen is the medical officer at the Vincent Pallotti Rehabilitation Centre (Cape Town) and is a member of the International Spinal Cord Society and the Southern African Neurological Rehabilitation Association. email: firstname.lastname@example.org