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BACKGROUND Elevated plasma levels of creatine kinase (CPK) are found in various neuromuscular conditions as a result of muscle damage and necrosis. Elevated CPK has also been described in elite wheelchair athletes and in able-bodied individuals after strenuous exercise. METHODS The incidence of elevated CPK in individuals with spinal cord injury (SCI) has not been well established. We reviewed laboratory data from 581 individuals with chronic SCI. RESULTS Most individuals with SCI (73.3%) had CPK values within 95% confidence intervals for able-bodied individuals. The highest levels were seen in African Americans (21% had CPK values > 95 confidence intervals for able-bodied individuals). Significant associations between CPK and the following independent variables were identified: impairment group, gender, duration of injury, body mass index, and ethnic group. Multiple regression analysis revealed significant correlations between CPK and oxygen consumption (beta .37, P < .01) in 32 individuals who performed the exercise test. CONCLUSIONS These findings are important for clinicians evaluating symptoms of fatigue and myopathy in individuals with SCI.

Nash MS, Lewis JE, Dyson-Hudson TA, Szlachcic Y, Yee F, Mendez AJ, Spungen AM, Bauman WA. Safety, tolerance, and efficacy of extended-release niacin monotherapy for treating dyslipidemia risks in persons with chronic tetraplegia: a randomized multicenter controlled trial. Objective To test the safety, tolerance, and efficacy of extended-release niacin monotherapy on dyslipidemia in persons with chronic tetraplegia. Design Placebo-controlled, blinded, multicenter, randomized controlled trial. Setting Three spinal cord injury research/rehabilitation centers. Participants Persons with chronic tetraplegia (N=54) and low plasma high-density lipoprotein cholesterol (HDL-C) levels. Intervention Extended-release niacin monotherapy (48 weeks; n=31) on a dose-titration schedule versus matched placebo (n=23). Main Outcome Measures Safety was assessed by using percentages of treatment-emergent adverse events and increased levels of hepatic transaminases, uric acid, glycosylated hemoglobin, and fasting glucose. Tolerance was assessed by using participant reports for frequency and intensity of adverse effects of extended-release niacin. Primary effectiveness outcomes were fasting HDL-C level and plasma total cholesterol (TC)/HDL-C ratio. Secondary outcomes included plasma low-density lipoprotein cholesterol (LDL-C) and TC levels and LDL-C/HDL-C ratio. Results Significant increases in fasting HDL-C levels (24.5%) were accompanied by decreases in TC/HDL-C and LDL-C/HDL-C ratios, LDL-C levels, and TC levels (all P Conclusions Extended-release niacin monotherapy is safe, tolerated, and effective for most persons with chronic tetraplegia. Special precautions for changes in bowel habits and postadministration hypotension should be observed.

The purpose of this study was to evaluate the effects of a simple dietary intervention for individuals with chronic spinal cord injury (SCI) and moderately elevated total cholesterol.Baseline and follow-up serum lipid values were obtained on 222 persons with SCI. Eighty-six individuals with total cholesterol200 mg/dL were referred for dietary consultation (group 1). The remainder with values200 mg/dL and no consultation served as controls (group 2).At average follow-up of 16 months, group 1 demonstrated significant declines in total cholesterol and low-density lipoprotein cholesterol (LDL-C), whereas group 2 demonstrated significant increases in total cholesterol. Triglyceride levels followed similar but nonsignificant patterns. There were no significant changes in high-density lipoprotein cholesterol for either group. In group 1, 17% had clinically significant reductions in total cholesterol to200 mg/dL and 21% had reductions of LDL-C from135 mg/dL to135 mg/dL.Dietary intervention should be an initial treatment for those with SCI and moderately elevated total cholesterol, with the expectation that approximately 20% will respond favorably.