Cardiovascular risk profiles among patients with multiple sclerosis and neuromyelitis optica spectrum disorder in...

While cardiovascular comorbidities are well described in multiple sclerosis (MS), they remain poorly characterized in neuromyelitis optica spectrum disorder (NMOSD). We aimed to identify cardiovascular risk associations in a Taiwanese cohort and compare risk profiles between MS and NMOSD.

A retrospective analysis was conducted using rigorously validated clinical records from a tertiary medical center in Taiwan (2016-2023). Patients diagnosed with MS (n = 48) or NMOSD (n = 17) were included. Standardized prevalence ratios (SPRs) were calculated to compare comorbidity rates with the general population. Pharmacological treatment patterns were analyzed to assess disease management burden.

MS patients exhibited a higher incidence of established cardiovascular events compared to NMOSD patients. SPR analysis revealed a significantly lower prevalence of dyslipidemia in both MS (SPR 0.45, 95% CI 0.18-0.93) and NMOSD (SPR 0.16, 95% CI 0.004-0.89) compared with the general population. However, dyslipidemia remained the strongest predictor of cardiovascular events in MS (p < 0.001). In NMOSD, despite a hypertension prevalence comparable to the general population (SPR 0.92), patients had significantly higher usage of angiotensin II receptor blockers (35.3% vs. 12.8%, p = 0.041) and direct oral anticoagulants (11.8% vs. 0%, p = 0.016), coinciding with universal corticosteroid use (100%).

Taiwanese MS and NMOSD patients exhibit distinct cardiovascular phenotypes. MS is characterized by a "lipid paradox" where dyslipidemia, though less prevalent, serves as a high-potency risk trigger. In NMOSD, cardiovascular risk is treatment-related and masked by high medication burden. Comprehensive risk assessment must prioritize these specific metabolic and iatrogenic factors.