MS confers elevated risks for vascular disease, death

  • Palladino R & al.
  • JAMA Neurol
  • 4 May 2020

  • curated by Susan London
  • Clinical Essentials
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Takeaway

  • Patients with multiple sclerosis (MS) have elevated risks for cardiovascular and cerebrovascular disease that traditional risk factors do not fully explain.

Why this matters

  • This population may especially need and benefit from preventive interventions.

Key results

  • Vs unaffected peers, patients with MS had elevated risks (HRs; 95% CIs) for:
    • Acute coronary syndrome: 1.28 (1.09-1.51).
    • Cerebrovascular disease: 1.59 (1.32-1.92).
    • Any macrovascular disease (acute coronary syndrome, cerebrovascular disease, peripheral arterial disease): 1.32 (1.15-1.52).
    • All-cause mortality: 3.46 (3.28-3.65).
    • Cardiovascular disease mortality: 1.47 (1.27-1.71).
  • Risk increases were greater among women than among men.
  • Compared with unaffected peers not taking lipid-lowering medications, risks (HRs; 95% CIs) were increased for:
    • All-cause mortality among:
      • All MS patients: 3.62 (3.43-3.83); and
      • MS patients taking these medications: 1.95 (1.58-2.42).
    • Cardiovascular disease mortality among:
      • All MS patients: 1.48 (1.26-1.73); and
      • MS patients taking these medications: 2.28 (1.51-3.43).

Study design

  • Population-based retrospective matched cohort study among general practice patients in England:
    • 12,251 with MS and
    • 72,572 without MS.
  • Main outcomes: cardiovascular, cerebrovascular events with mean 11.3-year follow-up.
  • Funding: National Institute for Health Research; others.

Limitations

  • Changing standards of care during study period.
  • Possible miscoding, misclassification.
  • Inability to control for some cardiovascular risk factors.