Coronary heart disease risk indicators, aerobic power, and physical activity in men with spinal cord injuries

Abstract

ABSTRACT.Janssen TWJ, van Oers CAJM, van Kamp GJ, TenVoorde BJ, van der Woude LHV, Hollander AP. Coronary heart disease risk indicators, aerobic power, and physical activity in men with spinal cord injuries. Arch Phys Med Rehabil 1997;78:697-705. Objective: To compare the lipid and (apo-)lipoprotein profile and blood pressure of men with long-standing spinal cord injuries (SCI) to those of an age-matched able-bodied (AB) population, and to assess the most important determinants of this profile and blood pressure.Design: A cross-sectional study of persons with chronic SC1 residing in the community.Setting: Tests were performed in a university research laboratory.Subjects: Thirty-seven men (age 37.4 2 12.0yrs) with longstanding (14.7 + 8.6yrs) SC1 ranging from level C4/5 to L5 volunteered to participate. Comparisons were made with published data from 3,498 AB men, age 20 to 59yrs, from the same country. Results: None of the lipid variables were related to the lesion level. TC, HDL-C, and TC/HDL-C were not significantly different from the AB population. The most important determinants of TC, LDL-C, and the ratios TCEIDL and HDL-C/LDL-C were age, smoking behavior, and activity level. Aerobic power was not an important determinant of any lipid or (apo-)lipoprotein or blood pressure.Conclusion: Men with long-standing SC1 do not appear to have an essentially different coronary heart disease risk profile compared with AB persons. Modifiable risk factors such as activity level, smoking, alcohol consumption, body mass index, and adipose tissue were more important than lesion level and aerobic power in the determination of the lipid and lipoprotein profile, suggesting several potential interventions. No commercial party having a direct or indirect interest in the subject matter of this article has or will confer a benefit upon the authors or upon any organization with which the authors are associated.Dr I NDIVIDUALS WITH spinal cord injuries (SCI) are at increased risk of coronary heart disease (CHD).' CHD is one of the most important causes of death in persons with SCL2 occurring at younger ages than in the able-bodied (AB) population. Some of the most important indicators of an increased risk are high serum concentrations of total cholesterol (TC) and low concentrations of high-density lipoprotein cholesterol (HDL-C).3 HDL-C levels have been reported to be significantly lower among persons with SC1 than in the AB population.4-9 In contrast, Cardus et al" did not find significant differences in total cholesterol (TC), HDL-C, and low-density lipoprotein cholesterol (LDL-C) between men with SC1 and age-matched AB men.It has been suggested that the lower HDL-C levels are due to an inactive lifestyle and a concomitant reduction of cardiopulmonary fitness of persons with SCI.7 In AB individuals an inverse relation has been reported between aerobic power, the most common measure of cardiopulmonary fitness, and TC, LDL-C, triglycerides (TG), and a direct relation between aerobic power and HDL-C, apolipoprotein A-l (apoA-1), ...

A review of body mass index and waist circumference as markers of obesity and coronary heart disease risk in persons with chronic spinal cord injury

“…Expressed as weight (kg) divided by height (m 2 ), BMI allows classification of able-bodied adults as underweight, normal weight, overweight or obese, using the World Health Organization criteria in Table 2. 12 Mean BMI values in studies of persons with long-standing SCI range from 20 to 27, 5,6,10,[13][14][15][16][17][18] consistent with the classifications of normal and overweight, but inconsistent with classification based on measured percent fat mass. [4][5][6][7][8][9][10][11] One reason for the underestimation of obesity using BMI may be the potential measurement error associated with determination of weight and/or height in persons with SCI.…”

“…20 Despite this, recalled height has been used in a number of studies reporting BMI in subjects with chronic SCI. 5,16,17 An alternative is to measure length. Jones et al 21 reported the Pearson's correlation coefficient for height (measured by wall-mounted stadiometer) versus length (by the electronic ruler function of DXA) to be 0.996 (P ¼ 0.0001).…”

“…14,15,[35][36][37] Triglyceride levels are 6-60% higher in SCI, although not always significantly so. 15,[35][36][37][38] Total and low-density lipoprotein (LDL) cholesterols are either higher, similar, or lower, than in able-bodied subjects; 15,16,37,39,40 the relatively small number of subjects and differences in subject characteristics studied may account for these discrepancies. Impaired glucose tolerance, insulin resistance and diabetes occur more frequently in SCI versus able-bodied persons.…”

“…BMI in other studies of persons with SCI has been found to explain 5-29% of the variance in lipid parameters. [16][17][18] The variable relationship between BMI and CHD risk factors in the SCI population may be due to the potential measurement error associated with BMI, the insensitivity of body weight in distinguishing fat mass from fat-free mass, and the lack of information conveyed by BMI regarding body fat distribution. Abdominal obesity, specifically visceral adipose tissue, is an independent risk factor for CHD in able-bodied populations.…”

Longitudinal association between lifestyle and coronary heart disease risk factors among individuals with spinal cord injury

“…6 However, behavioral factors can also be associated with unfavorable changes in body mass and lipid profile. Previous studies found an effect of smoking, 7 alcohol consumption, body mass, active lifestyle 7 and fitness 8 on lipid profiles in individuals with SCI. The effect of these lifestyle factors on body mass seems less clear 7 or has not yet been investigated.…”