Cardiovascular Disease Study

Coronary heart disease (CHD) is a leading cause of death in the spinal cord injured (SCI)
population, occurring at younger ages than in the able-bodied population. Conventional risk
factors for CHD include high concentrations of low-density lipoprotein (LDL), low
concentrations of high-density lipoprotein (HDL), diabetes mellitus (DM), smoking history,
and family history. Other factors that may influence progression of CHD include C-reactive
protein (an inflammatory marker), and fibrinogen (a pro-coagulant marker). Individuals with
SCI with longer duration and greater completeness of injury are more likely to have
significantly worse carbohydrate tolerance compared to other neurological deficit subgroups.
Muscle atrophy after SCI is associated with increased insulin resistance. Prolonged
inactivity has been shown to be associated with hyperinsulinemia and impaired glucose
tolerance. Body composition changes after SCI to indicate significantly more total body fat
mass and percent fat and less lean mass compared to able-bodied individuals. Carotid
intima-media thickness is correlated with atherosclerosis progression and abdominal
adiposity. Individuals with abdominal adiposity are at a higher risk for CHD, DM,
hypertension, insulin resistance, and dyslipidemia. Abdominal adiposity and insulin
resistance are contributors to postprandial lipemia, which may be a more sensitive indicator
of CHD risk and progression.

The purpose of this study is to determine the prevalence of conventional risk factors by
assessing the 10-year risk for CHD, and identify emerging risk factors for CHD in the spinal
cord injured population. Subjects will have the option to participate in a high fat meal
test to determine postprandial lipemic responses. Knowledge of this information may be able
to detect and prevent future cardiovascular events related to CHD.