How do cholesterol levels affect persons with spinal cord injury (SCI)?
The health management of individuals newly affected by SCI, along with better long-term follow-up care (particularly that of the bladder), has made a significant positive difference to their average life expectancy. This has resulted in a shift in the traditional cause of death among the SCI population. Some 30 years ago, complications related to the urinary tract accounted for most deaths, but today SCI persons are more likely to die from cardiovascular causes. Therefore the need for preventive strategies, including a focus on cardiovascular risk factor management in order to decrease long-term mortality, has become increasingly important.
After suffering a spinal cord injury people experience adverse changes in body composition. They tend to increase body fat and there is a relatively marked reduction in muscle mass and/or atrophy of muscle – these changes occur at an increased rate. Inactivity predisposes persons with SCI to metabolic abnormalities that tend to accelerate the development and appearance of coronary artery disease. Insulin resistance tends to occur, and increased levels of insulin in the blood become apparent, accompanied by associated disorders in carbohydrate and lipid metabolism. The ability of the pancreas to compensate for these changes may diminish with the duration of the injury and advancing age.
Simply put, persons with SCI are prone to increased risk of diabetes and coronary heart disease. Cholesterol comprises several types. Normally, the “good fat” in cholesterol (HDL) is found in lower levels in SCI persons when compared with the general population. This together with a higher prevalence of insulin resistance and diabetes mellitus, as well as an earlier occurrence of coronary heart disease (CHD), places SCI individuals at risk.
Exercise is one of the important lifestyle factors that can reduce cardiovascular risk. As exercise is difficult in SCI, diet plays an important role in regulating these abnormalities. Part of the annual monitoring should be a lipid screen. Early detection of low blood levels of HDL (good cholesterol) and higher than expected LDL and triglycerides (the “bad” fats) should initially be managed with diet. This means avoidance of products high in saturated animal fats, which raise blood levels of the bad fats. Meats should be lean cuts and eaten in moderation. Patients with SCI should be taking extra supplements of Omega 3 fatty acids as these are cardio protective.
Good cholesterol foods include olive oil, beans and legumes, whole grains, high-fibre fruit, fatty fish, flax seed, nuts, etc. Bad cholesterol foods include butter, hard margarines, lard, dripping and goose fat, fatty meat and meat products such as sausages, full fat cheese, milk, cream and yoghurt.
If dietary changes are insufficient to increase the good fats and lower bad fats, one should consider medications to lower cholesterol – the so-called “statins”.
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