Risk factors for coronary heart disease in patients with spinal cord injury in Turkey

Abstract

Objective: To compare the standard risk factors for coronary heart disease (CHD), de®ned in National Cholesterol Education Program II (NCEP II) of Turkish spinal cord injury (SCI) patients with healthy controls, discuss the results according to the ®ndings in Turkish population, and SCI patients in the literature. Design: We assessed 52 age and sex matched healthy control subjects, and 69 SCI patients (16 females, 53 males with the mean age of 33.9+11.37 years) with time since injury of 12.8+13.45 months. The study consisted of 45 paraplegics, and 24 tetraplegics with 54% incomplete, and 46% complete injury. Results: Risk factors for CHD according to NCEP II were; age and sex in 16%, positive family history in 0%, cigarette smoking in 54%, hypertension (HT) in 0%, high total cholesterol (TC) in 32%, high low-density lipoprotein cholesterol (LDL) in 41%, low highdensity lipoprotein cholesterol (HDL) in 52%, and diabetes mellitus (DM) in 7% of our SCI patients, respectively. Compared to controls DM, high TC, LDL, and low HDL were statistically more frequent in SCI patients. We found a negative correlation between serum HDL and time since injury. TC (186+32 vs 205+36; P=0.025), TC/HDL (5.34+1.17 vs 6.26+1.5; P=0.005), and LDL/HDL (3.57+0.9 vs 4.16+1.3; P=0.027) were signi®cantly increased in patients with time since injury of more than 1 year, while HDL levels (35.8+6.36 vs 33.86+6.47; P=0.213) decreased without reaching statistical signi®cance. The lipid pro®les did not show any correlation with the neurological level, and completeness of lesions. Conclusions: SCI confers additional CHD risk over that present inherently in the parent population due to enforced sedentary lifestyle and this increases with time since injury.The preliminary study consisting of 26 patients was accepted for poster presentation in

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.…”

“…High-density lipoprotein (HDL) cholesterol levels are 20-42% lower (Po0.05) in persons with SCI than in able-bodied persons. 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. 15,38,[41][42][43][44][45] Other potential CHD risk factors after SCI include decreased physical activity, psychosocial factors (depression, isolation), and elevated plasma homocysteine and C-reactive protein. 46 Increased fat mass has also been identified as an important risk factor in chronic SCI and weight management is recommended as a key CHD prevention strategy.…”

“…Three studies 11,15,63 have measured waist circumference in subjects with chronic SCI. Jeon et al 11 did not report values, nor was the method of obtaining waist circumference described.…”

Cardiometabolic risk factors in Iranians with spinal cord injury: Analysis by injury-related variables

“…Because of their relative inactivity and adverse body composition changes [5][6], persons with SCI are predisposed to increased rates of impaired glucose tolerance (IGT), insulin resistance and diabetes mellitus (DM) [7], reduced high-density lipoprotein cholesterol (HDL-C) (20%-42% lower than in nondisabled persons) [8][9], high low-density lipoprotein cholesterol (LDL-C) [8][9][10], and increased serum triglyceride (TG) (6%-60% higher than in nondisabled persons) [6,[8][9].…”