Non-conventional hemostatic risk factors for coronary heart disease in individuals with spinal cord injury

• Published in: Spinal cord Vol. 49; no. 8; pp. 858 - 866
• Main Authors: Khan, B, Bauman, W A, Sinha, A K, Kahn, N N
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01.08.2011; Nature Publishing Group
• Subjects: 631/250/2152/2153/1291; 631/378/1687/1825; 692/499; 692/699/75/593/15; Anatomy; Arteriosclerosis; Atherogenesis; Biological and medical sciences; Biomedical and Life Sciences; Biomedicine; Blood Platelets - metabolism; Cerebrospinal fluid. Meninges. Spinal cord; Coronary Disease - epidemiology; Coronary Disease - etiology; Coronary heart disease; Diabetes mellitus; Epoprostenol - metabolism; Etiology; Hemostatics - metabolism; Human Physiology; Humans; Hyperactivity; Hyperlipidemia; Immunoglobulin G; Injuries of the nervous system and the skull. Diseases due to physical agents; Insulin; Insulin receptors; Medical sciences; Nervous system (semeiology, syndromes); Neurochemistry; Neurology; Neuropsychology; Neurosciences; Nitric Oxide - metabolism; Platelet aggregation; Platelet-derived growth factor; Platelet-Derived Growth Factor - metabolism; prostacyclin PGI2; PubMed - statistics & numerical data; Receptor mechanisms; review; Reviews; Risk Factors; Spinal Cord Injuries - epidemiology; Spinal cord injury; Thrombin; Thrombin - metabolism; Thrombosis; Time Factors; Traumas. Diseases due to physical agents; Tritium - metabolism; coronary heart disease; antibody; insulin; prostacyclin; platelets; Pancreatic hormone; Nervous system diseases; Vertebral canal; Hemostatic; Prostaglandin I2; Cardiovascular disease; Coronary heart disease; Insulin; Platelet; Spinal cord trauma; Central nervous system disease; Risk factor; Spinal cord disease
• DOI: 10.1038/sc.2011.33
• ISSN: 1362-4393; 1476-5624

Study design: Review. Objectives: In subjects with spinal cord injury (SCI), there is strong evidence for platelet hyperactivity, which may stimulate atherosclerosis and coronary heart disease (CHD). The literature was reviewed. Background: Individuals with SCI develop premature CHD. In addition to the conventional risk factors associated with CHD, there are pathologic hematological factors involved in atherogenesis that are similar to those that have been demonstrated in individuals with diabetes, and these hematological factors might affect individuals with SCI. One such hematological factor, platelet aggregation, is essential for the development of CHD, which results from thrombus formation in the coronary vasculature. Prostacyclin (PGI 2 ) is a potent inhibitor of platelet aggregation and is thought to have a beneficial role in inhibiting atherogenesis; therefore, it is possible that individuals with SCI have impaired PGI 2 receptor function. Methods: We reviewed the literature by conducting a search using PubMed (1970–2007). Results: Acute thrombosis is emerging as an important factor in the etiology of CHD and therefore could mediate the risk of CHD in persons with SCI, in addition to previously known risk factors such as hyperlipidemia, hypertension, hyperlipidemia, diabetes mellitus and hyperinsulinemia. Because PGI 2 may retard atherogenesis through its inhibitory effects on platelet function, we discuss the effects of PGI 2 on platelets in persons with SCI in this review. Conclusions Subjects with chronic SCI develop abnormal platelet function, resulting in the production of atherogenic and thrombogenic factors for the following reasons: (1) the PGI 2 and insulin receptors on their platelets are impaired; (2) thrombin generation and platelet-derived growth factor release are elevated; (3) insulin-induced nitric oxide production by platelets is markedly impaired; and (4) a circulating antibody (immunoglobulin G (IgG)) blocks the antithrombotic effect of both insulin and PGI 2 receptors. Thus, this IgG molecule is thought to be one of the pathological mediators of the increased incidence of CHD in individuals with SCI.