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Thread: Risk factors for coronary heart disease in patients with spinal cord injury in Turkey

  1. #1

    Risk factors for coronary heart disease in patients with spinal cord injury in Turkey

    • Demirel S, Demirel G, Tukek T, Erk O and Yilmaz H (2001). Risk factors for coronary heart disease in patients with spinal cord injury in Turkey. Spinal Cord. 39 (3): 134-8. Summary: OBJECTIVE: To compare the standard risk factors for coronary heart disease (CHD), defined in National Cholesterol Education Program II (NCEP II) of Turkish spinal cord injury (SCI) patients with healthy controls, discuss the results according to the findings in Turkish population, and SCI patients in the literature. DESIGN: We assessed 52 age and sex matched healthy control subjects, and 69 SCI patients (16 females, 53 males with the mean age of 33.9+/-11.37 years) with time since injury of 12.8+/-13.45 months. The study consisted of 45 paraplegics, and 24 tetraplegics with 54% incomplete, and 46% complete injury. RESULTS: Risk factors for CHD according to NCEP II were; age and sex in 16%, positive family history in 0%, cigarette smoking in 54%, hypertension (HT) in 0%, high total cholesterol (TC) in 32%, high low-density lipoprotein cholesterol (LDL) in 41%, low high-density lipoprotein cholesterol (HDL) in 52%, and diabetes mellitus (DM) in 7% of our SCI patients, respectively. Compared to controls DM, high TC, LDL, and low HDL were statistically more frequent in SCI patients. We found a negative correlation between serum HDL and time since injury. TC (186+/-32 vs 205+/-36; P=0.025), TC/HDL (5.34+/-1.17 vs 6.26+/-1.5; P=0.005), and LDL/HDL (3.57+/-0.9 vs 4.16+/-1.3; P=0.027) were significantly increased in patients with time since injury of more than 1 year, while HDL levels (35.8+/-6.36 vs 33.86+/-6.47; P=0.213) decreased without reaching statistical significance. The lipid profiles did not show any correlation with the neurological level, and completeness of lesions. CONCLUSIONS: SCI confers additional CHD risk over that present inherently in the parent population due to enforced sedentary lifestyle and this increases with time since injury.The preliminary study consisting of 26 patients was accepted for poster presentation in Copenhagen, Denmark (18-20 June 1999) at the 38th Annual Scientific Meeting of IMSOP in association with the Nordic Medical Society of Paraplegia. <http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11326322> Cardiovascular Diseases Research Centre, Istanbul University Medical Faculty, Istanbul, Turkey.

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    diabetes mellitus (DM) in 7% of our SCI patients.
    Here it is again... A 7% incidence of diabetes seems very high to me. Why do people with spinal cord injury have such a high incidence of diabetes?

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    This is pure speculation, but could one reason for this higher rate be the people were pre-diabetic before their injuries, and that their normal activities kept the diabetes in control? Recent research has shown that maintaining exercise is one way to help delay the onset of type 2 diabetes. Often after a SCI, exercise (especially with the large muscle groups) is no longer done or is not possible. (jah)

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    JAH, it is a good idea. Another possibility is that diabetes is an autoimmune disease and much data suggest that the antibodies in diabetes target the decarboxylase enzyme that breaks down GABA and that this enzyme is present in the Islet of Langerhorn. One possibility is that spinal cord injury caused the release of the enzyme into the bloodstream and the body developed autoimmune antibodies that then attacked the Islet cells.

    The Russians have been focussing on neural autoimmunity recently. For example, Dimitriy telling us that they were testing people with spinal cord injury for the presence of antibodies against common neural antigens, including GFAP, neuron-specific enolase, neurofilaments, etc.

    Wise.

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