The role of arteriosclerosis (i.e., narrowing and hardening of the arteries) on the development of CVD is clear (Grey et al. 2003). Persons with SCI appear to be particularly susceptible to the development of arteriosclerosis (Bravo et al. 2004). Researchers have revealed that persons with SCI exhibit a series of risk factors for arteriosclerosis and thus CVD (as shown in Table 2).
A healthy endothelium (interior lining of blood vessels) is essential for the protection against arteriosclerosis (Anderson 2003). Increasing evidence has examined the vascular health of persons with SCI (de Groot et al. 2005; Zbogar et al. 2008; Phillips et al. 2011), and the effects of exercise training on vascular health in SCI (see recent systematic review of Phillips et al. 2011). However, the volume and level of evidence is quite limited in comparison to what is known about vascular health in the general population and other chronic conditions (such as heart disease, hypertension, diabetes) (Phillips et al. 2011). The majority (if not all) of the risk factors for CVD in persons with SCI will have a significant negative impact upon vascular health and function. As such, it is likely that vascular dysfunction is a central step in the development of CVD in persons with SCI.
Various authors have demonstrated reduced peripheral vascular function and/or arterial compliance in SCI (Table 1); however, others have highlighted that when appropriate controls are applied certain markers of endothelial function (e.g., endothelium-dependent and -independent vasodilatation of the superﬁcial femoral artery) may not be appreciably different from the general population (de Groot et al. 2004, Thijssen et al. 2008).