• August 17th, 2018

Take Heart: Improving Cardiometabolic Care after Spinal Cord Injury

Cardiac disease is the silent killer in America. Half of all deaths in the United States are related to Cardiometabolic diseases (Mueller, JAMA, 2017).  According to the federally funded SCI National Database (Facts and Figures, SCIstats@uab.edu), while septicemia and pneumonia have remained the leading causes of death after SCI since the 1970s, endocrine, metabolic and nutritional diseases have seen a significant increase in the past ten years.

In April 2018, Paralyzed Veterans of America, in collaboration with the Consortium of SCI Medicine, published the Identification and Management of Cardiometabolic Risk after SCI Clinical Practice Guideline (CPG) to guide healthcare providers in helping veterans and others living with SCI prevent or manage these deadly diseases. The CPG is available for download at www.pva.org/publications and the Apple Store at no cost and the print publication can be purchased for $10 (order form on the same site).

What do these Guidelines mean to you? There are now recommendations for people living with SCI, based on an extensive review of spinal cord injury literature and expert experience, reviewed by field experts, which provide your physicians and other providers with strong direction in treating and preventing Cardiometabolic disease. While the guidelines were founded in recommendations for the general populations, they include essential issues related to spinal cord injury.

You are urged to download or purchase the paper manual and share it with your medical team.

Below are some of the key recommendations included in the guidelines.

Cardiometabolic Disease (CMD)

Use the American Heart Association (AHA) definition, and the five constituent hazards of obesity, insulin resistance, dyslipidemia (including individual risks of low high-density lipoprotein cholesterol [HDL-C] and elevated Triglyceride [TG]), and hypertension as CMD risk components for persons with SCI. Evaluate all individuals with new SCIs before discharge from rehabilitation and those living with SCI now at the first opportunity (clinic visit).

Obesity

Assess obesity beginning at the time of discharge from rehabilitation: Where possible measure body composition using 3- or 4-compartment models to report obesity in adults with SCI until validated, clinically appropriate equations become available. Classify adult men with >22%body fat and adult women with >35% body fat as obese, and at high risk for CMD. Follow-up testing at least every three years following initial assessment when tests are normal in asymptomatic adults with SCI. When BMI is used as a surrogate marker for obesity in persons with SCI, BMI ≥22 kg/m2 is the cutoff point for obesity. Adult men and women with BMI ≥22 kg/m2 are at high risk for CMD.

Follow-up testing at least every three years following initial assessment when tests are normal in asymptomatic adults with SCI.

Diabetes / Prediabetes

Screen adults with SCI for diabetes and prediabetes, and repeat testing at least every three years if tests are normal.

Hypertension (high blood pressure)

Adopt AHA guidelines as the primary methods of assessment for BP measurement in persons with SCI.  Blood pressure should be measured at every routine visit – and at least annually.  Elevated BP readings should be confirmed on a separate patient visit to diagnose hypertension.

Dyslipidemia (high cholesterol)

Surveillance in asymptomatic adults with SCI of fasting LDL  TC, TG and HDL-C at least every three years when tests are first normal. Annual screening of persons with SCI in the presence of multiple risk factors, or when evidence of dyslipidemia is confirmed or treatment initiated.

Physical Activity

Individuals with SCI should participate in at least 150 minutes per week of physical exercise according to their ability beginning as soon as possible following acute spinal cord injury. The 150 minutes per week guideline can be satisfied by sessions of 30-60 minutes performed 3-5 days per week, or by exercising for at least three, 10-minute sessions per day.  When individuals with SCI are not able to meet these guidelines, they should engage in regular physical activity according to their abilities and should avoid inactivity. They should consult their health-care provider about the amounts and types of physical activity that are appropriate for their abilities.

You only have one heart, you need to protect it!

Information for this blog post was compiled from the PVA publication Identification and Management of Cardiometabolic Risk after SCI, Mark S. Nash, PhD and Suzanne Groah MD.

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