Journal CME July 2026: Increased symptomatic autonomic dysfunction is associated with greater cardiovascular endothelial dysfunction following spinal cord injury-PM R - 2025 - Pramanik - Increased symptomatic autonomic dysfunction is associated with greater cardiovascular endothelial

PM R - 2025 - Pramanik - Increased symptomatic autonomic dysfunction is associated with greater cardiovascular endothelial

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This case-control study examined whether symptomatic blood pressure instability in people with spinal cord injury (SCI) is linked to objective vascular endothelial dysfunction, a contributor to cardiovascular disease. Twenty-four adults with traumatic SCI and 14 age-, sex-, and BMI-matched uninjured controls completed the Autonomic Dysfunction Following SCI (ADFSCI) survey and underwent brachial artery flow-mediated dilation (FMD) testing after forearm occlusion.<br /><br />Compared with controls, participants with SCI reported much more symptomatic autonomic dysfunction and showed significantly worse endothelial function, with lower percent FMD and lower allometrically scaled FMD. In the SCI group, higher ADFSCI scores were moderately and significantly correlated with worse vascular dysfunction (R² = 0.24), whereas no such relationship was seen in controls. Neurological level of injury was not meaningfully correlated with FMD.<br /><br />The authors conclude that, in SCI, more severe symptoms of orthostatic hypotension and autonomic dysreflexia are associated with greater endothelial dysfunction. This suggests that blood pressure instability may be an important, modifiable cardiovascular risk factor after SCI, alongside traditional factors such as exercise, lipid control, and glycemic control. Future longitudinal studies are needed to determine whether treating autonomic dysfunction can improve vascular health and reduce cardiovascular disease risk.

Keywords

spinal cord injury

blood pressure instability

autonomic dysfunction

endothelial dysfunction

flow-mediated dilation

orthostatic hypotension

autonomic dysreflexia

cardiovascular risk

vascular health

brachial artery