Daniel Rapp1, Sebastian Michels2, Jakob Schöpe3, Lukas Schwingshackl4, Hayrettin Tumani5, Makbule Senel6. 1. Department of Neurology, University of Ulm, Oberer Eselsberg 45, 89081 Ulm, Germany. Electronic address: daniel.rapp@uni-ulm.de. 2. Department of Neurology, University of Ulm, Oberer Eselsberg 45, 89081 Ulm, Germany. Electronic address: sebastian.michels@uni-ulm.de. 3. Institute for Medical Biometry, Epidemiology and Medical Informatics, Saarland University, Homburg, Saarland, Germany. Electronic address: schoepe@med-imbei.uni-saarland.de. 4. Institute for Evidence in Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany. Electronic address: schwingshackl@cochrane.de. 5. Department of Neurology, University of Ulm, Oberer Eselsberg 45, 89081 Ulm, Germany; Fachklinik für Neurologie Dietenbronn, Dietenbronn 7, 88477 Schwendi, Germany. Electronic address: hayrettin.tumani@uni-ulm.de. 6. Department of Neurology, University of Ulm, Oberer Eselsberg 45, 89081 Ulm, Germany. Electronic address: makbule.senel@uni-ulm.de.
Abstract
BACKGROUND: Observational studies have described associations between multiple sclerosis (MS) and heart diseases, but the results were mixed. METHODS: Medline, Embase, and Cochrane CENTRAL were searched up to 5 October 2020 according to a protocol (PROSPERO registration number CRD42020184493). We included longitudinal non-randomized studies of exposure comparing the incidence of acquired heart diseases between people with multiple sclerosis (pwMS) and people without multiple sclerosis. We used ROBINS-E and the GRADE approach to assess risk of bias and the certainty of evidence, respectively. Data were pooled using random-effect models. RESULTS: Of 5,159 studies, nine studies met the inclusion criteria. MS was associated with an increased risk for myocardial infarction (HR 1.6, 95% CI 1.2 to 2.0, I2 86%, n = 1,209,079) and heart failure (HR 1.7, 95% CI 1.3 to 2.2, I2 49%, n = 489,814). The associations were more pronounced among women and younger people in subgroup analyses. We found no difference for ischemic heart disease (HR 1.0, 95% CI 0.8 to 1.4, I2 86%, n = 679,378) and bradycardia (HR 1.5, 95% CI 0.4 to 5.0, I2 50%, n = 187,810). The risk of atrial fibrillation was lower in pwMS (HR 0.7, 95% CI 0.6 to 0.8, I2 0%, n = 354,070), but the risk of bias was high, and the certainty of evidence was rated as very low. One study found more cases of infectious endocarditis among pwMS (HR 1.2, 95% CI 1.0 to 1.4, n = 83,712). CONCLUSIONS: Myocardial infarction and heart failure should be considered in people with multiple sclerosis during follow-up examinations.
BACKGROUND: Observational studies have described associations between multiple sclerosis (MS) and heart diseases, but the results were mixed. METHODS: Medline, Embase, and Cochrane CENTRAL were searched up to 5 October 2020 according to a protocol (PROSPERO registration number CRD42020184493). We included longitudinal non-randomized studies of exposure comparing the incidence of acquired heart diseases between people with multiple sclerosis (pwMS) and people without multiple sclerosis. We used ROBINS-E and the GRADE approach to assess risk of bias and the certainty of evidence, respectively. Data were pooled using random-effect models. RESULTS: Of 5,159 studies, nine studies met the inclusion criteria. MS was associated with an increased risk for myocardial infarction (HR 1.6, 95% CI 1.2 to 2.0, I2 86%, n = 1,209,079) and heart failure (HR 1.7, 95% CI 1.3 to 2.2, I2 49%, n = 489,814). The associations were more pronounced among women and younger people in subgroup analyses. We found no difference for ischemic heart disease (HR 1.0, 95% CI 0.8 to 1.4, I2 86%, n = 679,378) and bradycardia (HR 1.5, 95% CI 0.4 to 5.0, I2 50%, n = 187,810). The risk of atrial fibrillation was lower in pwMS (HR 0.7, 95% CI 0.6 to 0.8, I2 0%, n = 354,070), but the risk of bias was high, and the certainty of evidence was rated as very low. One study found more cases of infectious endocarditis among pwMS (HR 1.2, 95% CI 1.0 to 1.4, n = 83,712). CONCLUSIONS: Myocardial infarction and heart failure should be considered in people with multiple sclerosis during follow-up examinations.