CORONARY-ARTERY DISEASE - METABOLIC RISK-FACTORS AND LATENT DISEASE IN INDIVIDUALS WITH PARAPLEGIA

Individuals with spinal cord injury (SCI) currently have a longer life span as a result of recent improvements in medical care. As in the ab le-bodied population, cardiovascular disease is the leading cause of d eath in persons with SCI, but it appears to occur at younger ages in t hose with SCI than in the able-bodied population. The reduction in lev el of activity and adverse changes in body composition caused by SCI h ave profound metabolic consequences that may influence the progression and severity of coronary artery disease. Metabolic sequelae of SCI in clude disorders of carbohydrate and lipid metabolism. Almost half of t he 45 active, healthy subjects with paraplegia we studied have a disor der of carbohydrate tolerance, 1 in 5 subjects having a diabetic oral glucose tolerance test. Hyperinsulinemia is found in those with abnorm al glucose tolerance. Subjects with paraplegia having impaired glucose tolerance or diabetes mellitus are significantly older than those wit h normal glucose tolerance. High-density lipoprotein cholesterol is ma rkedly depressed, and low density lipoprotein is relatively elevated. Radionuclide myocardial perfusion imaging after upper body ergometry e xercise reveals latent coronary artery disease in 12 of 19 subjects wi th paraplegia.