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M - Cardiovascular Integrity

Cardiovascular Integrity | Body Structure and Function M Miyatani, PhD; A Krassioukov, MD, PhD; D Ditor, PhD; C Craven, MD; M Verrier, MHSc; and the E-Scan Investigative Team The cardiovascular system, which includes the heart and blood vessels, is responsible for the transport of oxygen-rich blood, throughout the body. Changes in this system, after spinal cord injury (SCI), lead to an increased propensity for cardiovascular disease (CVD). CVD refers to any disease that affects the cardiovascular system, including heart disease, heart attack, heart valve disease, heart failure, peripheral vascular disease, hypertension, stroke and abnormal heart rhythms. Maintaining cardiovascular integrity, in individuals with SCI, involves the prevention and management of CVD risk factors, linked to lifestyle changes and autonomic dysfunction, after injury. Development of CVD in individuals with SCI is not simple and results from the interactions of physiologic processes, such as gender, aging and genetic factors, and a variety of SCI-induced risk factors, such as lifestyle changes, stress and anxiety, autonomic dysfunction, metabolic changes and elevated inflammatory cytokines (Figure 1.0).1,2 Common lifestyle changes, after SCI, include physical inactivity, poor nutrition and smoking, which contribute to alterations in cardiovascular integrity. Individuals with SCI develop virtually all the major lifestyle risk factors for CVD, as do the able bodied, over time, including abdominal obesity, lipid disorders and diabetes or glucose intolerance - with the exception of smoking.3 The autonomic nervous system regulates unconscious body functions including heart rate, blood pressure, sweating, temperature regulation, and metabolic and endocrine responses to stress. Autonomic dysfunction (or disorders of the autonomic nervous system) is extremely common in individuals with SCI above T6, leading to cardiovascular consequences: autonomic dysreflexia (AD),4 orthostatic hypotension (OH)5 and abnormal heart rhythms (arrhythmias). In addition, paralysis after SCI results in a series of metabolic consequences, which include increased abdominal and visceral obesity, reduced muscle mass, changes in muscle fibre type (preponderance of type II fibres), and activation of inflammatory and prothrombotic biomarkers. Appropriate assessments, intervention and/or management of these risk factors should reduce CVD-related mortality and morbidity, associated with these health conditions. Routine cardiovascular integrity screening is essential for primary and secondary prevention of CVD, improved quality of life, wellbeing and survival. CARDIOVASCULAR INTEGRITY | BODY STRUCTURE AND FNUCTION 127


M - Cardiovascular Integrity
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