Cardiovascular Diseases Clinical Trial
Official title:
The Swedish Spinal Cord Injury Study on Cardiopulmonary and Autonomic Impairment
The main aim of this study is to gain an in-depth knowledge of cardiopulmonary and autonomic health consequences, and related risk factors among people with long-term high-level spinal cord injury. The result of this study will form the basis for further research to improve prevention strategies and risk prediction of cardiopulmonary disorders in people with spinal cord injury.
Life expectancy for people with spinal cord injury (SCI) has increased during the 20th
century as a result of improvements in health care systems and the environment. The incidence
of SCI is stable and as a consequence the prevalence of SCI has increased globally leading to
a growing population of persons aging with SCI. Therefore, SCI research need to focus on the
physiology of aging to prevent premature cardiovascular and pulmonary diseases, which are the
leading causes of death.
The disruption of sensory-, motor- and autonomic pathways causes major neurological deficits
which alter the physiologic conditions. Among people with SCI above the mid-thoracic level
dysfunction in pulmonary, autonomic cardiovascular regulation and emerging metabolic
cardiovascular risk factors are well-known. In addition, paralysis of the abdominal and
thoracic musculature causes restrictive pulmonary dysfunction, weak cough and atelectasis
contributing to the mortality in SCI.
Cardiovascular disease (CVD) is more prevalent and occurs earlier in life among people with
SCI compared to the general population. The increased prevalence of traditional risk factors
cannot, however, fully explain these findings. Cardiovascular autonomic dysfunction has been
hypothesized to contribute to the increased risk. The need for advances in risk management is
therefore important as the first symptoms of coronary atherosclerosis are commonly sudden
death or acute coronary syndrome. This is further complicated by the sensory loss and reduced
ability to perform strenuous activities leading to asymptomatic disease as typical symptoms
of exertional angina pectoris does not manifest. Risk assessment tools, such as Framingham
risk score or Systematic Coronary Risk Evaluation (SCORE), are available but lack the
precision in people with SCI as these tools are calibrated on the general population.
The Swedish Spinal Cord Injury Study on Cardiopulmonary and Autonomic Impairment - SPICA -
was initiated to assess the effects of aging with SCI on the cardiovascular, pulmonary and
autonomic systems in a cohort of middle-aged persons with long-term SCI. SPICA combines
advanced imaging techniques, likely to play an important role in risk stratification of CVD
and pulmonary disease in the future, with functional analyses, and generic and SCI-specific
assessment tools.
The overarching aim of SPICA is to assess and extensively characterize the cardiopulmonary
and autonomic health status in middle-aged persons with a severe and high-level SCI. The
study will elucidate the cardiopulmonary health consequences specific to persons living with
a SCI through comparison of results to matched controls. The results of SPICA will advance
the investigator's knowledge in this field and thereby improve prevention strategies and risk
prediction of CVD and pulmonary disorders in people with SCI.
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