Multiple sclerosis tied to increased risk for stroke

Takeaway

• This meta-analysis suggests that patients with multiple sclerosis (MS) are at an increased risk for developing any type of stroke, particularly ischaemic stroke compared with the general population.

Why this matters

• MS and stroke are the two most common causes of death and disability worldwide, but the association between these 2 diseases remains unclear.

Study design

• Meta-analysis of 9 studies involving >380,000 participants identified after a search across MEDLINE, Embase and other databases.
• Funding: National Key R&D Program of China.

Key results

• Patients with MS vs those without were at increased risk for any type of stroke during 1 (risk ratio [RR], 3.48; 95% CI, 1.59-7.64; P=.002; I², 90%) and 10-13 years (RR, 2.45; 95% CI, 1.90-3.16; P<.00001; I², 66%) of follow-up.
• Male veterans with MS had higher prevalence of any type of stroke vs those without MS (RR, 2.00; 95% CI, 1.19-3.38; P=.009; I², 93%) and the general population (RR, 2.93; 95% CI, 1.13-7.62; P=.03; I², 98%).
• After 1-year of follow-up, ischaemic stroke was more common in the patients with MS vs those without (RR, 6.09; 95% CI, 3.44-10.77; P<.00001).
• In sub-group analysis:
  • The risk for any type of stroke was significantly higher in middle-aged (RR, 2.07; 95% CI, 1.71-2.50) and elderly (RR, 1.94; 95% CI, 1.56-2.42; P<.00001) patients with MS vs those without.
  • Men (RR, 2.20; 95% CI, 1.72-2.80; I², 84%) and women (RR, 2.09; 95% CI, 1.75-2.50; I², 69%) with MS were at increased risk for any type of stroke vs those without.

Limitations

• Heterogeneity among studies.
• Independent analyses of lifestyle factors, social status, education, and other factors were not performed.