Krum H, Howes L G, Brown D J, Ungar G, Moore P, McNeil J J, Louis W J
Clinical Pharmacology Unit, Austin Hospital, Heidelberg, Victoria, Australia.
Paraplegia. 1992 Jun;30(6):381-8. doi: 10.1038/sc.1992.87.
To establish whether the reported increased cardiovascular (CV) morbidity in spinal cord injury (SCI) patients is due to increased levels of established CV risk factors, we assessed overall CV risk in 102 consecutive patients aged 25-64 by calculation of a 'risk factor score' (RFS) derived from the MRFIT study (age, diastolic blood pressure (DBP), total cholesterol (TC) level, cigarettes/day, sex), obtaining a percentile position amongst an age and sex matched peer group from the 1983 Australian Risk Factor Prevalence Study. Chronic SCI patients had a very low overall percentile position of risk of 26.03 + 15.06 (mean +/- S.D.) and those patients with SCI for greater than 10 years had only a slightly higher risk position of 33.16 +/- 29.66. The low relative risk in SCI patients was due mainly to significantly lower DBP levels (67 +/- 13 mm hg), as TC levels (5.38 +/- 1.60 mmol/L) and cigarette consumption (31% smokers, mode 11-20/day) were similar to the control population (83 +/- 12 mmHg, 5.68 +/- 1.2 mmol/L, 28% smokers, mode 11-20/day, respectively). As other known risk factors such as lipoprotein cholesterol fractions were not included in the RFS index, these were measured in 327 consecutive SCI patients. HDL cholesterol levels, which are negatively correlated with CV risk, were significantly lower in SCI patients (1.12 +/- 0.30 mmol/L) compared to controls (1.35 +/- 0.35 mmol/L) and those patients more than 10 years post SCI had still lower levels (1.02 +/- 0.40). These data suggest that the reported increased incidence of CV disease in SCI patients is unexplained by increases in BP, TC or smoking. However, low HDL levels may contribute to CV risk and the role of other risk factors such as increased vascular reactivity remain to be established.
为确定脊髓损伤（SCI）患者心血管（CV）发病率增加是否归因于既定心血管危险因素水平升高，我们通过计算源自多重危险因素干预试验（MRFIT）研究（年龄、舒张压（DBP）、总胆固醇（TC）水平、每日吸烟量、性别）的“危险因素评分”（RFS），评估了102例年龄在25至64岁之间的连续患者的总体心血管风险，并在1983年澳大利亚危险因素患病率研究的年龄和性别匹配的同龄人组中获得百分位数排名。慢性SCI患者的总体风险百分位数非常低，为26.03 + 15.06（平均值 +/- 标准差），而那些SCI超过10年的患者的风险百分位数仅略高，为33.16 +/- 29.66。SCI患者相对风险较低主要是由于DBP水平显著较低（67 +/- 13 mmHg），因为TC水平（5.38 +/- 1.60 mmol/L）和吸烟量（31%吸烟者，模式为每日11 - 20支）与对照人群相似（分别为83 +/- 12 mmHg、5.68 +/- 1.2 mmol/L、28%吸烟者，模式为每日11 - 20支）。由于RFS指数未纳入其他已知危险因素，如脂蛋白胆固醇组分，我们对327例连续的SCI患者进行了测量。与CV风险呈负相关的高密度脂蛋白（HDL）胆固醇水平在SCI患者中显著低于对照组（1.12 +/- 0.30 mmol/L）（对照组为1.35 +/- 0.35 mmol/L），且SCI超过10年的患者水平更低（1.02 +/- 0.40）。这些数据表明，报道的SCI患者中CV疾病发病率增加无法用血压、TC或吸烟增加来解释。然而，低HDL水平可能会增加CV风险，而其他危险因素如血管反应性增加的作用仍有待确定。
