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Journal of Cardiopulmonary Rehabilitation & Prevention

April 2011, Volume 31 Number 2 , p 73 - 80


  • Suzanne L. Groah MD, MSPH
  • Mark S. Nash PhD
  • Emily A. Ward MS
  • Alexander Libin PhD
  • Armando J. Mendez PhD
  • Patricia Burns MS
  • Matt Elrod PT, DPT
  • Larry F. Hamm PhD


Cardiovascular disease (CVD) is a major health concern for persons with spinal cord injury (SCI)1,2 and currently represents the most frequent cause of death among persons surviving more than 30 years after SCI (46% of deaths) and among persons older than 60 years with SCI (35% of deaths).3 When excluding deaths during the first year after injury, all-cause CVD is the leading source of mortality in long-term SCI.4 This was confirmed by the Boston SCI cohort study, in which circulatory diseases were the most common or contributing cause of mortality, accounting for 41% of deaths.5 These data emphasize the need for evidence to better understand causes, risk factors, and predictors of CVD, specific for the SCI population.Cardiometabolic syndrome is defined through a clustering of cardiovascular risk factors, primarily identified as overweight/obesity, atherogenic dyslipidemia, hypertension, and insulin resistance,6,7 and is thought to better characterize CVD and endocrine risks that impart a health hazard. To a lesser extent, the defined risks include a prothrombotic state and elevated levels of proinflammatory cytokines. Cardiometabolic risk (CMR) is currently considered so threatening to health and well-being that it has fueled a named initiative, "Heart of Diabetes," by the American Diabetes Association and American Heart Association, targeting greater focus on evidence-based prevention, recognition, and treatment of all risk factors for diabetes and CVD.8 Using the National Heart, Lung and Blood Institute National Cholesterol Education Program Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults (NCEP ATP III) guidelines,9,10 Nash and Mendez11 found that the combination of abdominal obesity, elevated fasting TG, low levels of fasting high-density lipoprotein cholesterol (HDL-C), hypertension, and fasting hyperglycemia was observed in more than 1 in 3 young, healthy persons with paraplegia.For coronary heart disease (CHD) risk prediction,

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