Diagnosis and Management of Cardiovascular Risk in Individuals with Spinal Cord Injury: A Narrative Review

Circulation, 2023 · DOI: 10.1161/CIRCULATIONAHA.123.064859 · Published: July 18, 2023

Spinal Cord Injury Cardiovascular Science Public Health

Simple Explanation

Spinal cord injury (SCI) can lead to chronic disability, and while medical care has improved life expectancy for individuals with SCI, cardiovascular disease (CVD) has become a leading cause of death in this population. People with SCI have a high occurrence of traditional CVD risk factors, experience physical and metabolic changes, and face barriers to healthcare because of their disability. Primary care doctors and heart specialists need to be more aware of the importance of diagnosing and managing heart risk factors in people with SCI.

Study Duration

Not specified

Participants

73 to 200 individuals across multiple studies

Evidence Level

Narrative Review

Key Findings

1
CVD develops earlier and is more severe in individuals with SCI, but existing studies have been limited by small sample sizes and older methods of assessing risk.
2
Individuals with SCI are more than twice as likely to have a diagnosis of type 2 diabetes compared to peers without SCI.
3
People with SCI have much higher rates of tobacco use compared with the general population.

Research Summary

Physiologic and metabolic changes that accompany SCI are likely to increase risk for CVD, and these hazards are compounded by poor recognition of risk factors, barriers to accessing care, and intersections with racial and socioeconomic health inequities. Research is needed to clarify the incidence and prevalence of CVD (and CVD risk factors) in people with SCI and to better identify the role of both traditional and nontraditional risk factors in CVD incidence. The most important first step to improving cardiovascular health for this vulnerable population, however, is for primary care physicians and cardiologists to be aware of the need for timely diagnosis and management of cardiac risk factors for people with SCI.

Practical Implications

Increased Awareness

Primary care physicians and cardiologists need to be more aware of the importance of timely diagnosis and management of cardiac risk factors for people with SCI.

Targeted Screening

Annual diabetes screening should be considered for all individuals with SCI, given the high prevalence of undiagnosed impaired glucose tolerance.

Address Social Determinants

Interventions to improve CVD prevention and treatment for people with SCI require collection and understanding of the SDOH burdens faced by this population.

Study Limitations

1
Lack of large studies with longitudinal collection of risk factors and adjudicated CVD events in the SCI population.
2
Classical symptoms of CVD events may be masked by sensory and autonomic dysfunction after SCI.
3
People with mobility impairment experience difficulties in obtaining preventive care and making appointments with subspecialists.

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