Risk Assessment for Coronary Heart Disease in a Veteran Population with Spinal Cord Injury

Persons with spinal cord injury (SCI) have premature coronary heart disease (CHD). Because of adverse changes in body composition and level of activity, there is an increased prevalence of abnormalities in carbohydrate and lipid metabolism. Hypertension appears to occur more frequently in persons with paraplegia. Knowledge of the relative risk of CHD in individuals with SCI would be important in determining appropriate intervention strategies. As such, the conventional risk factors for CHD, as defined by the Third Report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III), were determined in a population of 224 veterans with SCI to assign risk to be able to determine target low-density lipoprotein cholesterol levels for therapeutic intervention. The average age of the patients was 49 ± 15 years, with a mean duration of injury of 17 ± 13 years. Diabetes mellitus (DM), a risk equivalent for CHD, was present in 38 patients (17%). Except for DM, CHD or other CHD risk equivalents were present in 9% of patients. Two or more CHD risk factors were present in 157 (70%) patients, of whom the 10-year risk of having a coronary event by Framingham risk scoring was between 10% and 20% in 87 patients (39%); only 4% of patients with 2 or more CHF risk factors had a 10-year risk of ≯20% by Framingham scoring. The potential limitations of ATP III guidelines when applied to the SCI population are discussed.