Cardiovascular Disease Study
Condition: Spinal Cord Injury
MeSH terms: Spinal Cord Injuries
Study type: Observational

Summary: 
      Coronary heart disease (CHD) is a leading cause of death in the spinal cord injured (SCI)
      population, occurring at younger ages than in the able-bodied population. Conventional risk
      factors for CHD include high concentrations of low-density lipoprotein (LDL), low
      concentrations of high-density lipoprotein (HDL), diabetes mellitus (DM), smoking history,
      and family history. Other factors that may influence progression of CHD include C-reactive
      protein (an inflammatory marker), and fibrinogen (a pro-coagulant marker). Individuals with
      SCI with longer duration and greater completeness of injury are more likely to have
      significantly worse carbohydrate tolerance compared to other neurological deficit subgroups.
      Muscle atrophy after SCI is associated with increased insulin resistance. Prolonged
      inactivity has been shown to be associated with hyperinsulinemia and impaired glucose
      tolerance. Body composition changes after SCI to indicate significantly more total body fat
      mass and percent fat and less lean mass compared to able-bodied individuals. Carotid
      intima-media thickness is correlated with atherosclerosis progression and abdominal
      adiposity. Individuals with abdominal adiposity are at a higher risk for CHD, DM,
      hypertension, insulin resistance, and dyslipidemia. Abdominal adiposity and insulin
      resistance are contributors to postprandial lipemia, which may be a more sensitive indicator
      of CHD risk and progression.

      The purpose of this study is to determine the prevalence of conventional risk factors by
      assessing the 10-year risk for CHD, and identify emerging risk factors for CHD in the spinal
      cord injured population. Subjects will have the option to participate in a high fat meal test
      to determine postprandial lipemic responses. Knowledge of this information may be able to
      detect and prevent future cardiovascular events related to CHD.
    


Intervention name(s): 2 hour Oral Glucose Tolerance Test; Fat Meal Test
Intervention type(s): Procedure; Procedure
Intervention description(s): Fasting baseline blood samples will be drawn for analysis of insulin and glucose. A 75-gram glucose solution will be administered and subjects remain sedentary for 2 hours. After 2 hours, blood is drawn to analyze post-load insulin and glucose levels.; A fasting blood draw is performed for analysis of lipids, insulin, and glucose. Subjects ingest a high fat meal (milkshake made from heavy whipping cream and premium ice cream) within 15 minutes. Postprandial blood draws at 2, 4, and 6 hours are made for analysis of lipids, insulin, and glucose.
Other intervention name(s): 2-hr OGTT
Observational model: Case-Control
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        Subjects will be recruited from hospital clinics, through advertisements, and referral from
        primary care physicians.
      
Biospecimen description: 
      serum and plasma
    
Keywords: Coronary Heart Disease; spinal cord injury; risk factor; postprandial lipemia