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Spinal cord injury may not increase risk of heart disease

Americans who live with spinal cord injury do not appear to be at greater risk of developing carbohydrate and lipid disorders such as insulin resistance, diabetes, impaired glucose tolerance, and high or low blood cholesterol levels - risk factors for heart disease - than able-bodied persons, according to a new evidence review by HHS' Agency for Healthcare Research and Quality.

More than a quarter million Americans live with a disability due to spinal cord injury, and 11,000 are hospitalized annually. Spinal cord injury is usually caused by a sudden traumatic blow to the spine such as from accidents or violent events, including combat.

The review's authors, who are with the AHRQ-supported Minnesota Evidence-Based Practice Center in Minneapolis, caution clinicians on depending on the Body Mass Index to assess obesity --- a key risk factor for developing diabetes and heart disease - in spinal cord-injured patients because it may underestimate their fat mass and is likely inaccurate. Spinal cord injured persons lose muscle mass that is replaced by fat mass.

In addition, the reviewers found no scientific support for establishing different standards for measuring carbohydrate and lipid disorders in spinal cord-injured persons versus the established ones for defining and treating these problems in people without such injuries.

The reviewers also caution researchers against attempting to use findings from studies of people without spinal cord injuries to estimate the effectiveness and harms of interventions, such as exercise, in spinal cord-injured people because they may have unique physiologic differences.

The reviewers recommend further research, including a large, prospective, multicenter cohort study of adults with spinal cord injury.

AHRQ's evidence report was requested and funded by the Paralyzed Veterans of America Spinal Cord Medicine Consortium.

The report released, Carbohydrate and Lipid Disorders and Relevant Considerations in Persons with Spinal Cord Injury is the newest analysis from AHRQ's Evidenced-based Practice Program. The complete report can be found at http://www.ahrq.gov/clinic/tp/carbliptp.htm.