by James Rimmer
The title of this month's column is probably not the best play on words but it does seem to get peoples' attention. Heart disease is the number one killer in the United States, and among people with disabilities it's having a similar effect. With medical advancements, greater access to health care, and improved living conditions, people with physical and cognitive disabilities are living substantially longer than they did in the last century, and only in rare cases are they dying from conditions that used to shorten their life expectancy such as pneumonia, influenza, tuberculosis, congenital heart defects, and infections. Physicians who specialize in health care for people with disabilities are starting to take notice that the physical dimensions of a broken heart are as important as the emotional ones.
Heart Disease in People with Disabilities
In a study published a few years ago in the journal Public Health Reports, researchers found that people with physical and cognitive disabilities were six times more likely to develop cardiovascular disease compared to people without disabilities. The table below shows that people with physical and developmental disabilities have a higher incidence of cardiovascular risk factors including smoking (except for the developmental disability group), high blood pressure, hypertension (except for the developmental disability group), physical inactivity, overweight/obesity and diabetes. These risk factors raise the risk of heart disease substantially and could pose a substantial health risk to people with disabilities as they move into their 50s and 60s.
Graph showing the Higher Prevalence of Cardiovascular Disease in People with Disabilities than People without Disabilities |
Prevalence of Health Risk Behaviors and Conditions Related to Heart Disease by Disability Group (%)
Risk Factor |
Disability Group |
Developmental Disability Group |
No Disability Group |
Smoking |
28.5 |
17.8 |
24.8 |
High blood cholesterol |
39.2a |
56.9b |
50.4c |
Hypertension |
47.5 |
16.0 |
20.7 |
Physical inactivity |
36.8 |
33.7 |
22.5 |
Overweight/obesity |
66.2 |
59.6 |
56.8 |
Diabetes |
15.2 |
7.9 |
3.9 |
Source: Data from Havercamp et al (2004) except for aBauman WA (2008), Spinal Cord, 46, 466-76 on Adults with SCI; bZigman WB (2007), Neuroscience Letters, 416, 279-84 on Adults with Down Syndrome; and cFord ES (2003), Circulation, 107, 2185-9.
New Reports on Heart Disease Confirm Older Studies
Two recent papers published last year by Buffart et al. (Archives of Physical Medicine and Rehabilitation, 89, 2167-73) and Bauman & Spungen (Spinal Cord, 46, 466-476) support earlier research that a significant percentage of people with disabilities (spina bifida and spinal cord injury) were at risk for cardiovascular disease. The researchers recommended that physicians and other health professionals pay closer attention to controlling certain preventable risk factors such as managing lipids, lowering blood pressure, increasing aerobic exercise, and reducing obesity. In the study by Buffart and colleagues, researchers reported that in adolescents and young adults with spina bifida, subjects were 13 times more likely to not have cardiovascular disease risk with increasing levels of aerobic fitness. Bauman and Spungen, two well known researchers in heart disease and spinal cord injury (SCI), noted that 'SCI predisposes the individual to medical complications such as lipid abnormalities, carbohydrate intolerance and an atherogenic pattern for coronary heart disease (CHD).' Low HDL levels (a risk factor for heart disease) were approximately two to four times higher among individuals with SCI compared to the general population. Other risk factors for heart disease were also higher among persons with SCI and the researchers concluded that various risk factors '...predispose persons with SCI to metabolic abnormalities that tend to accelerate the development and appearance of CHD [coronary heart disease].'
And so, on this Valentine's Day, let this be a wake up call to physicians, health care providers and people with disabilities that heart disease is one way to a broken heart. In some cases, it is the quickest way.