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Published on: February 16, 2011
Traditional risk factors may not explain increased incidence of myocardial infarction in MS
Ruth Ann Marrie1, Allan Garland2, Stephen Allan Schaffer2
1From the Department of Internal Medicine (R.A.M., A.G., S.A.S.), Department of Community Health Sciences (R.A.M., A.G., R.F., S.L.), and Manitoba Centre for Health Policy (R.F., M.Y.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg; and Department of Medicine (Neurology) (E.K., H.T.), University of British Columbia and The Djavad Mowafaghian Centre for Brain Health, Vancouver, Canada. rmarrie@hsc.mb.ca.
Insights
Individuals with multiple sclerosis (MS) face an elevated risk of acute myocardial infarction (AMI). This increased risk persists even when accounting for common vascular health factors, suggesting a complex relationship.
Area of Science:
- Cardiovascular epidemiology
- Neurology
- Public health research
Background:
- Multiple sclerosis (MS) is a chronic autoimmune disease affecting the central nervous system.
- Cardiovascular disease, including acute myocardial infarction (AMI), is a significant cause of mortality.
- The relationship between MS and cardiovascular risk requires further investigation, particularly concerning traditional risk factors.
Purpose of the Study:
- To compare the incidence of acute myocardial infarction (AMI) in individuals with multiple sclerosis (MS) versus a matched cohort without MS.
- To determine if traditional vascular risk factors explain the potential difference in AMI risk between MS patients and controls.
Main Methods:
- A retrospective matched cohort study utilized administrative health claims data from British Columbia and Manitoba, Canada.
- Incident multiple sclerosis (MS) cases were identified using a validated definition, with up to five controls per case matched on age, sex, and region.
- Incidence rate ratios (IRR) and Cox proportional hazards regression were employed to compare AMI risk, adjusting for sociodemographic factors and vascular conditions (diabetes, hypertension, hyperlipidemia). Findings were pooled using meta-analysis.
Main Results:
- The study included 14,565 individuals with MS and 72,825 matched controls.
- Age-standardized incidence of AMI was higher in the MS population (IRR 1.18; 95% CI 1.03-1.36).
- After adjustment for covariates, the hazard of AMI was 63% higher in the MS cohort (hazard ratio 1.63; 95% CI 1.43-1.87).
Conclusions:
- The risk of acute myocardial infarction (AMI) is significantly elevated in individuals with multiple sclerosis (MS).
- Traditional vascular risk factors do not fully account for the increased AMI risk observed in the MS population.
- Further research is warranted to understand the underlying mechanisms contributing to heightened cardiovascular risk in MS.
Objective:
To compare the risk of incident acute myocardial infarction (AMI) in the multiple sclerosis (MS) population and a matched population without MS, controlling for traditional vascular risk factors.
Methods:
We conducted a retrospective matched cohort study using population-based administrative (health claims) data in 2 Canadian provinces, British Columbia and Manitoba. We identified incident MS cases using a validated case definition. For each case, we identified up to 5 controls without MS matched on age, sex, and region. We compared the incidence of AMI between cohorts using incidence rate ratios (IRR). We used Cox proportional hazards regression to compare the hazard of AMI between cohorts adjusting for sociodemographic factors, diabetes, hypertension, and hyperlipidemia. We pooled the provincial findings using meta-analysis.
Results:
We identified 14,565 persons with MS and 72,825 matched controls. The crude incidence of AMI per 100,000 population was 146.2 (95% confidence interval [CI] 129.0-163.5) in the MS population and 128.8 (95% CI 121.8-135.8) in the matched population. After age standardization, the incidence of AMI was higher in the MS population than in the matched population (IRR 1.18; 95% CI 1.03-1.36). After adjustment, the hazard of AMI was 60% higher in the MS population than in the matched population (hazard ratio 1.63; 95% CI 1.43-1.87).
Conclusion:
The risk of AMI is elevated in MS, and this risk may not be accounted for by traditional vascular risk factors.
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