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Comprehensive Autopsy Program for Individuals with Multiple Sclerosis
Published on: July 19, 2019
Hypertension and heart disease are associated with development of brain atrophy in multiple sclerosis: a 5-year
D Jakimovski1, S Gandhi1, I Paunkoski1
1Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA.
Insights
Cardiovascular diseases like hypertension and heart disease accelerate brain atrophy in multiple sclerosis (MS) patients. These conditions did not increase lesion accumulation, but indicate neurodegeneration detectable by MRI.
Area of Science:
- Neurology
- Cardiology
- Radiology
Background:
- Cardiovascular diseases (CVDs) are more prevalent in multiple sclerosis (MS) patients.
- CVDs are associated with increased lesion load and brain atrophy in MS.
Purpose of the Study:
- To determine if CVDs accelerate lesion accumulation and brain atrophy over five years in MS patients.
Main Methods:
- 194 MS patients and 43 controls were followed for 5 years.
- CVDs and risk factors were assessed via questionnaires and medical records.
- Brain atrophy and lesion progression were evaluated using 3T MRI and analyzed with ANCOVA.
Main Results:
- Heart disease patients showed greater white matter and whole brain volume loss.
- Hypertension in MS patients correlated with increased lateral ventricle volume.
- CVDs did not significantly increase lesion volume accrual over the study period.
Conclusions:
- Hypertension and heart disease contribute to brain atrophy in MS patients.
- CVDs may indicate neurodegenerative processes detectable by MRI in MS.
- CVDs do not appear to accelerate lesion accrual in MS.
Background:
Cardiovascular diseases (CVDs) are more frequent in multiple sclerosis (MS) patients when compared to controls. In particular, CVDs are linked with higher accumulation of lesions and advanced brain atrophy.
Objective:
To investigate whether CVDs contribute to accelerated lesion accumulation and brain atrophy over 5 years in patients with MS.
Methods:
194 MS patients and 43 controls without neurologic disease were followed for 5 years. Full physical, neurological evaluation, and structured questionnaire investigating CVD and risk factors (hypertension, hyperlipidemia, heart disease, smoking, diabetes, obesity/overweight) were collected using interview-based questionnaire and further cross-reference with electronic medical records. Lesion and brain atrophy outcomes were assessed with 3T MRI. ANCOVA adjusted for age, gender, and disease duration were used accordingly. False discovery rate correction was performed using Benjamini-Hochberg correction.
Results:
Patients with diagnosis of heart disease showed higher white matter and whole brain volume loss compared to those without (-4.2% vs. -0.7%, P = 0.01 and -3.4% vs. -1.6%, P = 0.01, respectively). The percentage lateral ventricle volume change in MS patients with hypertension was higher compared to non-hypertensive patients (24.5% vs. 14.1%, P = 0.05). Hyperlipidemia, smoking, and obesity/overweight were not associated with progression of MRI-derived outcomes. CVDs did not contribute to larger lesion volume accrual over the 5-year period. The presence of CVDs was not associated with MRI-derived changes in the controls.
Conclusions:
Hypertension and heart disease contribute to advanced brain atrophy in MS patients. CVDs did not contribute to additional lesion accrual. CVD comorbidities in MS patients may contribute to neurodegenerative tissue injury that can be detected with brain MRI.
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