Multiple sclerosis (MS) is associated with an increased risk of cardiovascular disease and mortality, but evidence from population-based studies has been sparse.
It is widely known that inflammation plays a role in cerebrovascular risk. A new population-based study confirms an increased risk of cardiovascular and cerebrovascular disease in MS patients that cannot be explained by traditional vascular risk factors alone. The cohort study from England has been published in the Journal of the American Medical Association (JAMA) in early May 2020. This study matched 12,251 MS patients with six people each without MS (n = 72,572) and followed up for eleven years.1
This made it possible to assess the risk of acute coronary syndrome, cerebrovascular disease, macrovascular complications (including occlusive peripheral arterial disease) and mortality corrected for socio-demographic variables and conventional vascular risk factors. Factors such as smoker status, diabetes, depression, urinary tract infections, medications (antihypertensives, lipid reducers, antidiabetics, antiplatelet aggregation inhibitors, anticoagulants), and the number of primary care physician contacts in the year of diagnosis were also considered.
This is particularly important as it is known from previous studies that people with MS have a higher prevalence of hypertension, hyperlipidemia, obesity, smoking, and lower levels of physical activity compared to the general population. Initial results were presented at the last ECTRIMS congress in 2019.2
According to this, MS patients not only had a higher risk of macrovascular complications but also a three-and-a-half times higher risk with regard to total mortality (HR 3.46; 95% CI: 3.28-3.65) and one-and-a-half times the higher risk with regard to cardiovascular mortality (HR 1.47; 95% CI: 1.27-1.71). The median age of patients in both cohorts was 45 years.
Compared to the matched controls from the population without MS, the risk of acute coronary syndrome was 28% higher, for cerebrovascular disease 59% higher, and for macrovascular disease 32% higher. Women (who made up two-thirds of the patients) showed more pronounced differences in macrovascular complications than men. They also had a higher risk of mortality.
Cardiovascular risk factors and morbidities are associated with faster disease progression. The authors concluded that given the negative impact of these comorbidities on outcomes in patients with MS, further research is needed. The study thus underlines the importance of close evaluation and control of vascular risk factors in MS patients in clinical practice.
References:
1. Palladino, R., Marrie, R. A., Majeed, A. & Chataway, J. Evaluating the Risk of Macrovascular Events and Mortality Among People With Multiple Sclerosis in England. JAMA Neurol (2020) doi:10.1001/jamaneurol.2020.0664.
2. Raffaele Palladino. Evaluating the risk of macrovascular events and mortality in individuals with multiple sclerosis in England: a population-based nested case-control study. https://onlinelibrary.ectrims-congress.eu/ectrims/2019/stockholm/279409/raffaele.palladino.evaluating.the.risk.of.macrovascular.events.and.mortality.html.