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Multiple sclerosis clinical course and cardiovascular disease risk - Swedish cohort study
H Roshanisefat1, S Bahmanyar, J Hillert
1Department of Neurology, Karolinska University Hospital Huddinge, Stockholm, Sweden; Neuroimmunology Unit, Centre for Molecular Medicine, Department of Clinical Neuroscience, Karolinska Institute and, Karolinska University Hospital, Solna, Stockholm, Sweden; Clinical Epidemiology Unit and, Centre for Pharmacoepidemiology, Department of Medicine, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden.
Insights
Multiple sclerosis (MS) patients face a higher risk of cardiovascular disease (CVD), especially venous thromboembolic disorders. This increased risk, particularly in progressive MS, highlights the need for targeted cardiovascular monitoring in these individuals.
Area of Science:
- Neurology
- Cardiology
- Epidemiology
Background:
- Cardiovascular disease (CVD) risk appears elevated in multiple sclerosis (MS) patients.
- Few studies have investigated CVD risk in unselected MS patient cohorts.
- The course of MS may influence CVD risk.
Purpose of the Study:
- To assess the overall CVD risk in an unselected group of MS patients.
- To determine if CVD risk varies based on the specific course of MS (relapsing-remitting, secondary progressive, primary progressive).
Main Methods:
- Utilized the Swedish Multiple Sclerosis Register to identify 7,667 MS patients diagnosed between 1964 and 2005.
- Matched MS patients with 76,045 individuals from the general population by age, time period, region, and sex.
- Employed Poisson regression to compare CVD relative risk between the MS and general population cohorts.
Main Results:
- MS patients exhibited a 1.31-fold increased adjusted relative risk for CVD compared to the general population.
- The highest CVD risk was observed for venous thromboembolic disorders, particularly in progressive MS.
- MS was associated with an increased risk of ischemic stroke, mainly within the first year post-diagnosis, and a decreased risk for angina pectoris and atrial fibrillation.
Conclusions:
- A significantly elevated CVD risk exists in MS patients, with venous thromboembolic disorders being particularly prominent in progressive MS.
- The increased incidence of ischemic stroke in MS is likely attributable to surveillance bias.
- No increased risk for ischemic heart disease was found in MS patients, and atrial fibrillation was less common.
Background And Purpose:
Cardiovascular disease (CVD) risk amongst multiple sclerosis (MS) patients appears raised, but few studies have examined CVD risk amongst an unselected MS patient group. MS course may be relevant for CVD risk. Our aim was to assess CVD risk and variation by course in MS patients.
Methods:
The Multiple Sclerosis Register identified 7667 patients who received an MS diagnosis between 1964 and 2005. They were matched by age, period, region and sex with 76 045 members of the general population without MS using Swedish registers. Poisson regression compared the two cohorts to estimate the relative risk for CVD, overall, as well as grouped and individual CVD diagnoses.
Results:
MS patients had an increased adjusted relative risk (with 95% confidence intervals; number of MS cohort events) for CVD of 1.31 (1.22-1.41; n = 847), with some variation by course: relapsing-remitting 1.38 (1.17-1.62; n = 168); secondary progressive 1.30 (1.18-1.53; n = 405) and primary progressive 1.15 (0.93-1.41; n = 108). The association for the relapsing-remitting course was not significant after excluding the first year of follow-up. Overall incidence rates per 1000 person-years for CVD are 11.8 (11.06-12.66) for the MS cohort and 8.8 (8.60-9.05) for the non-MS cohort. The most pronounced association was for deep vein thrombosis: relapsing-remitting 2.16 (1.21-3.87; n = 14), secondary progressive 3.41 (2.45-4.75; n = 52) and primary progressive 3.57 (1.95-6.56; n = 15). MS was associated with ischaemic stroke but largely during the first year of follow-up. MS was associated with a decreased relative risk for angina pectoris and atrial fibrillation.
Conclusions:
There is a significantly increased relative risk for CVD in MS, particularly for venous thromboembolic disorders in progressive MS, suggesting immobility as a possible factor. An increased frequency of ischaemic stroke in MS is most probably due to surveillance bias resulting from diagnostic investigations for MS. There is no increased relative risk for ischaemic heart disease in MS and atrial fibrillation appears to be less common than amongst the general population.
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