Management of cardiovascular disease risk factors in individuals with chronic spinal cord injury: an evidence-based review

Abstract

Clinical scenario: A 37-year-old man suffered a complete spinal cord injury (C8, American Spinal Injury Association Impairment Scale [ASIA] score A) 10 years ago in a car accident. Should primary prevention of cardiovascular disease be a priority in this patient? In order to answer this question, we performed a systematic review of the literature to inform an evidence-based clinical review. The objective was to provide a comprehensive and up-to-date review of the clinical management of cardiovascular disease (CVD) and risk factors for individuals with spinal cord injury (SCI). Comprehensive literature searches were performed. The quality of each study was assessed using the Physiotherapy Evidence Database Scale for randomized controlled trials, and the Downs and Black Scale for all other studies. Levels of evidence were assigned using a modified version of Sackett's scale. Our findings indicate that CVD is a critical issue in individuals with chronic SCI. Almost all risk factors for CVD are amplified in individuals with SCI, including physical inactivity, dyslipidemia, blood pressure irregularities, abnormal glycemic control, and chronic inflammation. However, there is a paucity of high-quality literature with respect to treatment outcomes in SCI-specific study populations (a total of 22 intervention studies in all of these categories combined) that allow for the development of evidence-informed clinical practice recommendations. These limitations notwithstanding, we present a series of contemporary practice suggestions with regard to CVD event risk modification in SCI patients. For optimal outcomes, health care providers should be cognizant of these heightened CVD risk factors and the resultant increased CVD morbidity and mortality in SCI patients. Despite the absence of high-quality evidence-based treatment strategies, clinicians should re-examine their own CVD risk factor treatment strategies to better reflect contemporary practice in similar high-CVD-event-risk patients and populations.