Incidence and associated outcomes of major adverse cardiovascular events in multiple sclerosis versus rheumatoid...

People with multiple sclerosis (pwMS) and rheumatoid arthritis (pwRA) have an increased cardiovascular disease (CVD) risk. As chronic inflammatory diseases with differing underlying mechanisms, they provide a useful comparison for understanding cardiovascular risk. We investigated major adverse cardiovascular event (MACE) incidence in pwMS, compared to pwRA.

A cohort study was conducted using anonymised healthcare data in TriNetX. PwMS or RA aged ≥55 years were diagnosed at least 5 years prior to the search and were 1:1 propensity-score matched for age, sex, ethnicity, pre-existing comorbidities, cardiovascular procedures and medications. Cox proportional hazard models determined 5-year incident MACE in pwMS, and associations between CVD risk factors and 5-year incident MACE were investigated. Associations were then compared between pwMS and pwRA.

Among 147,933 pwMS, 8-12% experienced a MACE within 5-years of a recording of MS diagnosis in the database with or without CVD risk factors. PwMS and CVD risk factors, with no previously experienced MACEs, had a higher rate of MACE (HR 1.13, 95%CI 1.08, 1.19) compared to those without CVD risk factors. Among pwMS, a significantly higher rate of stroke (HR 1.28, 95% CI 1.22, 1.35) and all-cause mortality (HR 1.09, 95% CI 1.06, 1.12) was observed compared to pwRA. Normal CRP levels (<3mg/L) were associated with a lower rate of subsequent MACE compared to high CRP levels (≥3mg/L) (HR 0.62, 95% CI 0.58, 0.66) in pwMS.

Major adverse cardiovascular events are relatively common in pwMS; those with CVD risk factors have a higher 5-year MACE incidence. PwMS had a higher rate of stroke and all-cause mortality compared to pwRA. CRP may be an important variable associated with future MACE in pwMS.