Raffaele Palladino1,2, Ruth Ann Marrie3,4, Azeem Majeed1, Jeremy Chataway5,6. 1. Department of Primary Care and Public Health, School of Public Health, Imperial College of London, London, United Kingdom. 2. Department of Public Health, Federico II University, Naples, Italy. 3. Department of Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada. 4. Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada. 5. Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, University College London Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, United Kingdom. 6. National Institute for Health Research, University College London Hospitals, Biomedical Research Centre, London, United Kingdom.
Abstract
Importance: People with multiple sclerosis (MS) are associated with an increased risk of cardiovascular disease and mortality; however, evidence from population-based studies is sparse. Objective: To assess whether the risk of macrovascular events and mortality differs among people with MS compared with a matched population without MS in England. Design, Setting, and Participants: A population-based retrospective matched cohort study was conducted in general practices registered with the Clinical Practice Research Datalink in England between January 1, 1987, and September 30, 2018, with a mean (SD) follow-up of 11.3 (6.5) years. A total of 12 251 patients with MS were matched with up to 6 people without MS (n = 72 572) by age, sex, and general practice. People with 3 or more diagnoses of MS recorded during the study period were included. The first MS diagnosis was considered as index date. Exposures: Multiple sclerosis status. Analyses were also stratified by sex. Main Outcomes and Measures: Main outcomes were acute coronary syndrome, cerebrovascular disease, any macrovascular disease (including peripheral arterial disease), and mortality (all-cause mortality and cardiovascular disease-specific mortality). Cox proportional hazards regression and Fine and Gray proportional subhazard regression models were used to assess differences in rates. Results: A total of 12 251 people with MS (66.9% women; mean [SD] age, 44.9 [13.3] years) were matched with 72 572 people without MS (69.8% women; mean [SD] age, 44.9 [13.3] years). As compared with people without MS, people with MS were associated with a 28% increased hazard of acute coronary syndrome (hazard ratio [HR], 1.28; 95% CI, 1.09-1.51), 59% increased hazard of cerebrovascular disease (HR, 1.59; 95% CI, 1.32-1.92), 32% increased hazard of any macrovascular disease (HR, 1.32; 95% CI, 1.15-1.52), 3.5-fold increased hazard of all-cause mortality (HR, 3.46; 95% CI, 3.28-3.65), and 1.5-fold increased hazard in cardiovascular disease mortality (HR, 1.47; 95% CI, 1.27-1.71). Differences in macrovascular events were more pronounced among women than men. Mortality risk was also higher for women than men. Treatment with lipid-lowering medications (mainly statins) was associated with lower mortality rates among people with MS. Conclusions and Relevance: This study suggests that MS is associated with an increased risk of cardiovascular and cerebrovascular disease that is not completely accounted for by traditional vascular risk factors. Given the adverse effects of these comorbidities on outcomes in patients with MS, further investigation is needed.
Importance: People with multiple sclerosis (MS) are associated with an increased risk of cardiovascular disease and mortality; however, evidence from population-based studies is sparse. Objective: To assess whether the risk of macrovascular events and mortality differs among people with MS compared with a matched population without MS in England. Design, Setting, and Participants: A population-based retrospective matched cohort study was conducted in general practices registered with the Clinical Practice Research Datalink in England between January 1, 1987, and September 30, 2018, with a mean (SD) follow-up of 11.3 (6.5) years. A total of 12 251 patients with MS were matched with up to 6 people without MS (n = 72 572) by age, sex, and general practice. People with 3 or more diagnoses of MS recorded during the study period were included. The first MS diagnosis was considered as index date. Exposures: Multiple sclerosis status. Analyses were also stratified by sex. Main Outcomes and Measures: Main outcomes were acute coronary syndrome, cerebrovascular disease, any macrovascular disease (including peripheral arterial disease), and mortality (all-cause mortality and cardiovascular disease-specific mortality). Cox proportional hazards regression and Fine and Gray proportional subhazard regression models were used to assess differences in rates. Results: A total of 12 251 people with MS (66.9% women; mean [SD] age, 44.9 [13.3] years) were matched with 72 572 people without MS (69.8% women; mean [SD] age, 44.9 [13.3] years). As compared with people without MS, people with MS were associated with a 28% increased hazard of acute coronary syndrome (hazard ratio [HR], 1.28; 95% CI, 1.09-1.51), 59% increased hazard of cerebrovascular disease (HR, 1.59; 95% CI, 1.32-1.92), 32% increased hazard of any macrovascular disease (HR, 1.32; 95% CI, 1.15-1.52), 3.5-fold increased hazard of all-cause mortality (HR, 3.46; 95% CI, 3.28-3.65), and 1.5-fold increased hazard in cardiovascular diseasemortality (HR, 1.47; 95% CI, 1.27-1.71). Differences in macrovascular events were more pronounced among women than men. Mortality risk was also higher for women than men. Treatment with lipid-lowering medications (mainly statins) was associated with lower mortality rates among people with MS. Conclusions and Relevance: This study suggests that MS is associated with an increased risk of cardiovascular and cerebrovascular disease that is not completely accounted for by traditional vascular risk factors. Given the adverse effects of these comorbidities on outcomes in patients with MS, further investigation is needed.
Authors: Olga Krökki; Risto Bloigu; Hanna Ansakorpi; Mauri Reunanen; Anne M Remes Journal: Mult Scler Relat Disord Date: 2013-07-18 Impact factor: 4.339
Authors: Scott A Lear; Weihong Hu; Sumathy Rangarajan; Danijela Gasevic; Darryl Leong; Romaina Iqbal; Amparo Casanova; Sumathi Swaminathan; R M Anjana; Rajesh Kumar; Annika Rosengren; Li Wei; Wang Yang; Wang Chuangshi; Liu Huaxing; Sanjeev Nair; Rafael Diaz; Hany Swidon; Rajeev Gupta; Noushin Mohammadifard; Patricio Lopez-Jaramillo; Aytekin Oguz; Katarzyna Zatonska; Pamela Seron; Alvaro Avezum; Paul Poirier; Koon Teo; Salim Yusuf Journal: Lancet Date: 2017-09-21 Impact factor: 79.321
Authors: Joel M Gelfand; Andrea L Neimann; Daniel B Shin; Xingmei Wang; David J Margolis; Andrea B Troxel Journal: JAMA Date: 2006-10-11 Impact factor: 56.272
Authors: Jeremy Chataway; Nadine Schuerer; Ali Alsanousi; Dennis Chan; David MacManus; Kelvin Hunter; Val Anderson; Charles R M Bangham; Shona Clegg; Casper Nielsen; Nick C Fox; David Wilkie; Jennifer M Nicholas; Virginia L Calder; John Greenwood; Chris Frost; Richard Nicholas Journal: Lancet Date: 2014-03-19 Impact factor: 79.321
Authors: Ruth Ann Marrie; Nadia Reider; Jeffrey Cohen; Olaf Stuve; Maria Trojano; Gary Cutter; Stephen Reingold; Per Soelberg Sorensen Journal: Mult Scler Date: 2014-12-22 Impact factor: 6.312
Authors: Hsueh-Sheng Chiang; Alka Khera; Barbara E Stopschinski; Olaf Stuve; John Hart; Brendan Kelley; Trung Nguyen Journal: Geriatrics (Basel) Date: 2022-06-05
Authors: Jessica Minnier; Mark R Emmett; Ruby Perez; Liang-Hao Ding; Brooke L Barnette; Rianna E Larios; Changjin Hong; Tae Hyun Hwang; Yongjia Yu; Christina M Fallgren; Michael D Story; Michael M Weil; Jacob Raber Journal: Sci Rep Date: 2021-07-21 Impact factor: 4.379
Authors: Thomas E Williams; Katherine P Holdsworth; Jennifer M Nicholas; Arman Eshaghi; Theodora Katsanouli; Henrietta Wellington; Amanda Heslegrave; Henrik Zetterberg; Chris Frost; Jeremy Chataway Journal: Neurol Neuroimmunol Neuroinflamm Date: 2022-01-14
Authors: Mark D Peterson; Paul Lin; Neil Kamdar; Christina N Marsack-Topolewski; Elham Mahmoudi Journal: Mayo Clin Proc Innov Qual Outcomes Date: 2021-12-23
Authors: Raffaele Palladino; Adam G Tabak; Kamlesh Khunti; Jonathan Valabhji; Azeem Majeed; Christopher Millett; Eszter P Vamos Journal: BMJ Open Diabetes Res Care Date: 2020-04
Authors: Marcello Moccia; Vincenzo Brescia Morra; Roberta Lanzillo; Ilaria Loperto; Roberta Giordana; Maria Grazia Fumo; Martina Petruzzo; Nicola Capasso; Maria Triassi; Maria Pia Sormani; Raffaele Palladino Journal: Int J Environ Res Public Health Date: 2020-05-13 Impact factor: 3.390