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Updated: Jun 18, 2025
The Multiple Sclerosis Performance Test MSPT: An iPad-Based Disability Assessment Tool
Published on: June 30, 2014
Comorbid onset of cardiovascular diagnosis and long-term confirmed disability progression in multiple sclerosis: A
Taylor R Wicks1, Dejan Jakimovski1, Jack Reeves1
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
People with multiple sclerosis (MS) and comorbid cardiovascular diseases (CVD) experience faster disability progression. Early or new onset of CVD significantly accelerates long-term disability in MS patients.
Area of Science:
- Neurology
- Cardiology
- Epidemiology
Background:
- People with multiple sclerosis (pwMS) exhibit a higher prevalence of cardiovascular diseases (CVD) than the general population.
- This increased prevalence exists despite comparable frequencies of cardiovascular risk factors.
Purpose of the Study:
- To investigate the impact of cardiovascular disease (CVD) diagnosis onset on the long-term confirmed disability progression (CDP) in people with multiple sclerosis (pwMS).
Main Methods:
- A cohort of 276 pwMS (including clinically isolated syndrome, relapsing-remitting, and progressive types) was followed for an average of 14.9 years.
- Retrospective review of electronic medical records identified CVD diagnoses (hypertension, hyperlipidemia, diabetes, heart disease) at baseline and during follow-up.
- Confirmed disability progression (CDP) was defined by specific increases in the Expanded Disability Status Scale (EDSS) score, sustained over time.
Main Results:
- pwMS with existing or new-onset CVD (n=213) showed significantly faster time to CDP (13.4 years) compared to CVD-free pwMS (n=63, 15.9 years), irrespective of baseline age and EDSS.
- The CVD diagnosis preceded CDP in 55.7% of cases, occurred after CDP in 38.4%, and was concurrent in 5.9%.
- CVD onset was associated with greater longitudinal disability accrual (increased EDSS score), even after adjusting for age and time effects.
Conclusions:
- Comorbid cardiovascular disease (CVD) diagnosis in people with multiple sclerosis (pwMS) is linked to accelerated long-term disability worsening.
- No specific temporal relationship was found between the onset of CVD and confirmed disability progression (CDP) within the CVD-diagnosed group.
Background:
People with multiple sclerosis (pwMS) have greater prevalence of comorbid cardiovascular diseases (CVD) when compared to the general population despite similar frequency of CV risk factors.
Objective:
Determine the impact of comorbid-onset of CVD diagnosis on long-term confirmed disability progression (CDP).
Methods:
276 pwMS (29 clinically isolated syndrome, 130 relapsing-remitting and 117 progressive) were clinically followed an average of 14.9 years, with a mean of 14.4 clinical visits. Retrospective electronic medical records (EMR) review determined CVD diagnoses (hypertension, hyperlipidemia, diabetes, and heart disease) at baseline and over the follow-up. CDP was determined with ≥1.0 point Expanded Disability Status Scale (EDSS) increase from EDSS <5.5, or ≥ 0.5-point increase from ≥5.5, and was sustained on next clinical visit.
Results:
A significantly shorter time to overall CDP was detected in 213 pwMS who had an existing (28 pwMS) or developed new onset (185 pwMS) of CVD, compared to 63 CVD-healthy pwMS over the follow-up (13.4 vs 15.9 years, Mantel-Cox p < 0.001), independent of baseline age and EDSS score. The CVD diagnosis preceded the CDP in 103 pwMS (55.7%), occurred after CDP in 71 pwMS (38.4%) and was concurrent in 11 pwMS (5.9%). Using mixed-effect models adjusted for significant age (F = 56.5, p < 0.001) and time effects (F = 67.8, p < 0.001), the CVD-onset diagnosis was associated with greater accrual of disability, as measured by longitudinal increase in EDSS score (F = 4.207, p = 0.04). Sex was not significant predictor of future disability in our cohort.
Conclusion:
PwMS with an existing or new onset of comorbid CVD diagnosis showed accelerated disability worsening over long-term. There was no temporal relationship between the onset of CVD and CDP within the group that had CVD-onset diagnosis.
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