International Collaboration on Repair Discoveries-ICORD, Division of Physical Medicine and Rehabilitation University of British Columbia, Vancouver, British Columbia, Canada.
J Neurotrauma. 2012 Jul 20;29(11):1999-2012. doi: 10.1089/neu.2012.2313.
Clinical scenario: A 37-year-old man suffered a complete spinal cord injury (C8, American Spinal Injury Association Impairment Scale [ASIA] score A) 10 years ago in a car accident. Should primary prevention of cardiovascular disease be a priority in this patient? In order to answer this question, we performed a systematic review of the literature to inform an evidence-based clinical review. The objective was to provide a comprehensive and up-to-date review of the clinical management of cardiovascular disease (CVD) and risk factors for individuals with spinal cord injury (SCI). Comprehensive literature searches were performed. The quality of each study was assessed using the Physiotherapy Evidence Database Scale for randomized controlled trials, and the Downs and Black Scale for all other studies. Levels of evidence were assigned using a modified version of Sackett's scale. Our findings indicate that CVD is a critical issue in individuals with chronic SCI. Almost all risk factors for CVD are amplified in individuals with SCI, including physical inactivity, dyslipidemia, blood pressure irregularities, abnormal glycemic control, and chronic inflammation. However, there is a paucity of high-quality literature with respect to treatment outcomes in SCI-specific study populations (a total of 22 intervention studies in all of these categories combined) that allow for the development of evidence-informed clinical practice recommendations. These limitations notwithstanding, we present a series of contemporary practice suggestions with regard to CVD event risk modification in SCI patients. For optimal outcomes, health care providers should be cognizant of these heightened CVD risk factors and the resultant increased CVD morbidity and mortality in SCI patients. Despite the absence of high-quality evidence-based treatment strategies, clinicians should re-examine their own CVD risk factor treatment strategies to better reflect contemporary practice in similar high-CVD-event-risk patients and populations.
一名 37 岁男性，10 年前在一场车祸中遭受完全性脊髓损伤（C8，美国脊髓损伤协会损伤量表 [ASIA] A 级）。在这名患者中，心血管疾病的一级预防是否应作为优先事项？为了回答这个问题，我们对文献进行了系统回顾，以便为循证临床评估提供信息。目的是提供全面和最新的综述，介绍心血管疾病（CVD）和脊髓损伤（SCI）个体的心血管疾病危险因素的临床管理。进行了全面的文献检索。使用物理治疗证据数据库量表评估随机对照试验的研究质量，使用唐斯和布莱克量表评估所有其他研究的研究质量。使用萨克特量表的改良版本分配证据水平。我们的研究结果表明，CVD 是慢性 SCI 个体的一个关键问题。几乎所有 CVD 的危险因素在 SCI 个体中都被放大，包括身体活动减少、血脂异常、血压异常、血糖控制异常和慢性炎症。然而，关于 SCI 特定研究人群的治疗结果的高质量文献很少（在所有这些类别中，总共只有 22 项干预研究），这使得无法制定循证临床实践建议。尽管存在这些局限性，但我们提出了一系列关于 SCI 患者 CVD 事件风险改变的当代实践建议。为了获得最佳结果，医疗保健提供者应该意识到这些增加的 CVD 危险因素，以及 SCI 患者由此导致的 CVD 发病率和死亡率增加。尽管缺乏高质量的基于证据的治疗策略，但临床医生应该重新审视自己的 CVD 危险因素治疗策略，以更好地反映类似高 CVD 事件风险患者和人群的当代实践。
