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The Framingham score is a marker of early disability progression in multiple sclerosis
Felipe C D Barros1, Felipe T L Menezes1, Natasha P A Bessa1
1Universidade Federal de São Paulo. São Paulo, Brazil.
Background:
Multiple sclerosis (MS) may have its prognosis affected by several cardiovascular risk factors. The Framingham Score is a systematic way to measure the biological interactions of cardiovascular risk factors and has been related to MS clinical outcomes.
Objective:
assess whether the Framingham score is associated with an increased risk of MS disability, as stated by the risk of reaching an Expanded Disability Status Scale (EDSS) score of 6 during follow-up in multiethnic population in a middle-income country.
Methods:
This retrospective study evaluates the relationship between the Framingham Score and the last visit EDSS score, calculated using a logistic regression model, with further adjustments for confounding risk factors and a decision tree algorithm analysis. Data was collected from a tertiary multiple sclerosis (MS) center for patients admitted between 1994 and 2019.
Results:
Among 2036 medical records, we included 284 patients for final analysis. Patients who reached an EDSS of 6 or more had a mean Framingham score of 9.9 versus 5.8 among those who did not reach such EDSS. There was a positive Spearman correlation between the Framingham general cardiovascular risk score and the last-visit EDSS (rₛ = 0.414, p < 0.001). In logistic regression models using EDSS ≥ 6 as the outcome, higher Framingham scores were associated with greater odds of disability in unadjusted analyses, but this association was attenuated after adjustment for age. Among patients with baseline EDSS 0-2.5, the Framingham score significantly predicted a higher final EDSS. In this group, 25.3% of those with a score >1.91 reached EDSS ≥ 6, versus 3.9% with a score ≤1.91.
Discussion:
Our study reported an association between cardiovascular risk, as measured by the Framingham score, and disability in MS, measured by the last visit EDSS score, in a middle-income MS cohort with access to DMD. Such correlation is stronger and statistically significant among patients with an EDSS between 0 and 2.5. There is an association between the Framingham score and a higher final EDSS in patients with multiple sclerosis when the cardiovascular risk factors are present in the early course of the disease.
Insights
Cardiovascular risk, measured by the Framingham Score, is linked to increased disability in multiple sclerosis (MS) patients. This association is particularly strong in early disease stages, highlighting the importance of managing cardiovascular health in MS prognosis.
Area of Science:
- Neurology
- Cardiology
- Public Health
Background:
- Prognosis of multiple sclerosis (MS) can be influenced by cardiovascular risk factors.
- The Framingham Score systematically assesses cardiovascular risk and its impact on MS outcomes.
Purpose of the Study:
- To determine if the Framingham Score predicts increased disability in MS, specifically reaching an Expanded Disability Status Scale (EDSS) of 6.
- To investigate this association in a multiethnic population within a middle-income country.
Main Methods:
- Retrospective analysis of 284 MS patients' medical records from 1994-2019.
- Logistic regression and decision tree algorithms were used to evaluate the relationship between Framingham Score and EDSS.
- Adjustments were made for confounding risk factors like age.
Main Results:
- Patients reaching EDSS 6+ had a higher mean Framingham Score (9.9) than those who did not (5.8).
- A significant positive correlation (rₛ = 0.414) was found between Framingham Score and last-visit EDSS.
- In early MS (EDSS 0-2.5), higher Framingham Scores significantly predicted greater disability, with 25.3% reaching EDSS ≥ 6 versus 3.9%.
Conclusions:
- Cardiovascular risk, assessed by Framingham Score, is associated with disability progression in a middle-income MS cohort.
- The association is stronger in patients with early-stage MS (EDSS 0-2.5).
- Managing cardiovascular risk factors early in MS may be crucial for mitigating long-term disability.
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