How should lipid abnormalities be managed in Spinal Cord Injury patients?
SCI persons of all ages appear to be at higher risk than the general population for cardiovascular disease [CVD], atherogenesis, and undesirable blood lipid values, likely related to enforced inactivity and immobilization. Important predictors of CVD risk in SCI patients include age, time since injury, activity level, smoking behavior, alcohol intake, and overweight or obese status. Modifiable risk factors such as obesity, inactivity, dietary factors, and smoking need to be addressed in individuals with SCI because of increased risk factors for diabetes mellitus and heart disease. Gender and ethnicity influence blood lipid values in chronic SCI, with women and African-Americans showing higher mean HDL-C levels than Caucasian and Latino males. Physical activity, including sports, swimming, electrical exercise, and body-weight supported treadmill training, may result in improvements in blood lipid parameters. Dietary intervention utilizing American Heart Asociation and American Dietetic Association Disorders of Lipid Metabolism Evidence Based Nutrition Practice guidelines may be included in the treatment of SCI persons with abnormal lipid levels. Dietary intervention should be included in the treatment of individuals with SCI whose total cholesterol levels are >200 mg/dl. It is recommended that a registered dietitian provide nutrition intervention, since individualized diet plans may promote increased compliance with dietary treatment. Because SCI is associated with increased risk for CVD, periodic screening for lipid abnormalities is recommended for all SCI patients in order to reduce morbidity and mortality.
- Grade I means there is Good/Strong evidence supporting the statement;
- Grade II is Fair;
- Grade III is Limited/Weak;
- Grade IV is Expert Opinion Only;
- Grade V is Not Assignable.
- High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
- Moderate (B) means we are moderately confident in the effect estimate;
- Low (C) means our confidence in the effect estimate is limited;
- Very Low (D) means we have very little confidence in the effect estimate.
- Ungraded means a grade is not assignable.