The National
Spinal Cord
Injury Association

Disability in the News Archive

Heart Disease Risk For Individuals With Spinal Cord Injury

The following summary is adapted and distributed for use with permission from Aspen Publishers, Inc., from:

• Topics in Spinal Cord Injury from Aspen Publishers, Inc.; and
• Topics in Spinal Cord Injury Rehabilitation. Carbohydrate and lipid metabolism in individuals after spinal cord injury. Bauman, W.A., 1997, 2(4):1-22. Aspen Publishers, Inc.

Recent research studies have found that people with spinal cord injury have an increased risk of developing coronary heart disease (CHD) at an earlier age than in the non-disabled population. In fact, it has been reported that cardiovascular diseases are the leading cause of death for persons with a spinal cord injury of more than 30 years and for those people with SCI who are more than 60 years of age (Whiteneck).

Certain risk factors for cardiovascular disease exist that are specific to the spinal cord injured population. People with SCI are generally more insulin resistant than the non-disabled population. This insulin resistance adversely effects the body's ability to use blood sugar normally. Insulin resistance results in multiple metabolic and blood pressure abnormalities that can increase the risk of developing the atherosclerotic-type of heart disease. These abnormalities include the development of non-insulin dependent diabetes mellitus, impaired glucose tolerance, high blood pressure (hypertension), high blood fat levels (triglycerides), with a lower level of the "beneficial" type of blood cholesterol (known as HDL-cholesterol) and relatively high levels of the "bad" type of blood cholesterol (known as LDL-cholesterol).

Contributing to the metabolic abnormalities are certain physical changes associated with spinal cord injury that increase the risk of CHD development. These include the loss of muscle mass due to atrophy below the level of the spinal cord lesion, an increase in body fat, and a general decrease in the ability to maintain cardiovascular or aerobic fitness. Recent studies by Bauman and Spungen demonstrated that people with a spinal cord injury who were less fit on a cardiovascular test were more likely to be insulin resistant.

People with spinal cord injury must use appropriate prevention strategies to reduce the risk of developing cardiovascular disease. Important goals include having proper screening tests for disorders of blood sugar, eating a healthy diet, not smoking, avoiding excessive alcohol, and participating in regular physical exercise. A knowledgeable medical professional can assist with obtaining these goals.

Prevention Strategies:

1. Obtain the proper screening tests for diabetes and insulin resistance. The most reliable test at this time is the oral glucose tolerance test rather than relying on only the fasting blood glucose level. Your physician can perform these blood tests.
2. Get regular physical exercise. Work to maintain the highest level of physical fitness and activity possible with your level of spinal cord injury. You are encouraged to consult with a physician prior to engaging in new exercise to determine your risks. You may want to seek out a knowledgeable provider to assist you with an exercise routine that is healthy and safe.
3. Eat a healthy diet. A diet low in fat and cholesterol is heart healthy. Diet and exercise together are most effective for maintaining or losing fat weight. Be aware that most height/weight charts are not accurate for determining the ideal weight in persons with spinal cord injury. These charts significantly underestimate obesity in the spinal cord injured population. Body composition testing gives more accurate information on a persons amount of body fat compared to lean or muscle mass. Eating healthy and exercising can help achieve or maintain your proper weight and reduce your risks for cardiovascular disease. A medical professional can assist with determining your ideal weight and making dietary recommendations.

   The dietary recommendations for persons with diabetes mellitus are specifically outlined by the Committee on Food and Nutrition of American Diabetes Association and are as follows:

   • 55% to 60% of total caloric intake should be in the form of carbohydrates;
   • 0.8 grams per 2.2 pounds of body weight should be taken in as protein;
   • total fat intake should be restricted to less than 30% of the total calories; and
   • cholesterol intake should be less than 300 mg/d.

4. Avoid drinking excessive alcohol.
5. Stop smoking.
6. Consult your physician regarding regular medical screening and potential medications that may assist with achieving these goals.

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