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THIS IS ALL WE NEED----SOMETHING MORE TO WORRY ABOUT.
Bob from Houston
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Date: Tue, 31 Mar 1998 15:11:31 -0800
Reply-To: Spinal Cord Injury Peer Net <scipin-l(AT)health.state.ny.us>
Sender: Spinal Cord Injury Peer Net <scipin-l(AT)health.state.ny.us>
From: tnp01(AT)health.state.ny.us
Subject: Heart Disease Risk for Individuals with SCI
To: Multiple recipients of list SCIPIN-L <scipin-l(AT)health.state.ny.us>
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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., from: 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. 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.
References:
Whiteneck, G. Learning from empirical investigations. In: Menter, R.,
Whiteneck, G., eds. Perspectives on Aging with Spinal Cord Injury. New
York: Demos Publications, 1992.
Bauman, W.A. & Spungen, A.M. Disorders of carbohydrate and lipid
metabolism in veterans with paraplegia or quadriplegia: A model of
premature aging. Metabolism. 1994, 43:949-956.
Source:
Adapted from: Bauman, W.A. Carbohydrate and lipid metabolism in
individuals after spinal cord injury. Topics in Spinal Cord Injury
Rehabilitation. 1997, 2(4):1-22 with permission from Aspen Publishers,
Inc.
Adaptation written by:
Lilli Thompson, P.T., Training Director
June Isaacson Kailes, Consumer Dissemination Specialist
Rehabilitation Research and Training Center on Aging and Spinal Cord
Injury Rancho Los Amigos Medical Center
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