CVD risk increased after spinal cord injury

To reduce morbidity and mortality due to CVD after a spinal cord injury, treatment should focus on autonomic dysfunction and lifestyle modification, a presenter said at the 2011 Canadian Cardiovascular Congress.

“In [people with spinal cord injuries] we should be looking at whether they have autonomic dysfunction, because this causes a higher risk for heart disease,” Rianne Ravensbergen, a PhD candidate at Simon Fraser University, said in a press release. “Spinal cord injury in humans is never clear-cut. We [do not] exactly know which pathways are affected … [or] how control of the CV system is affected.”

Ravensbergen and colleagues conducted a study to determine the relationships between severity of autonomic dysfunction after spinal cord injury and risk factors for CVD. The study included 20 participants with spinal cord injury and 14 without. Those with spinal cord injury were divided into subgroups of participants with or without autonomic dysfunction.

The spinal cord injury group had decreased glucose tolerance and increased total and abdominal fat mass. The researchers also found an association between low frequency systolic arterial pressure power, noradrenaline levels and glucose intolerance in that group.

When the researchers examined the subgroups with and without autonomic dysfunction, they found that both groups had high cholesterol, but that with autonomic dysfunction also had problems with blood glucose. “These are people in a prediabetic state, which elevates their risk for heart disease,” Ravensbergen said.

Other results showed that participants with impaired glucose tolerance had increased adiposity and larger waist circumferences. Lower physical activity levels were also associated with glucose tolerance, but not with severity of autonomic dysfunction. Moreover, severity of autonomic dysfunction was not associated with measures of adiposity.

The data indicate that after the recovery period, there is value in screening the autonomic system to evaluate the CV system of spinal cord patients. Whether an increased risk for CVD is truly due to the spinal cord injury or related to patient characteristics after such injury remains to be sorted out.

Further research is needed to investigate the role that autonomic nerves play; how to better measure and improve autonomic function; and the best ways to prevent CVD after spinal cord injury, the researchers concluded.

Disclosure: Ravensberger reports to relevant financial disclosures.

For more information:

Ravensberger HJ. #307-322. Presented at: 2011 Canadian Cardiovascular Congress; Oct. 24-26; Vancouver.

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