Cardiovascular Conditions Common in Both Patients With Demyelinating Diseases and Unaffected Individuals, Study Finds

Patients who suffer from cardiovascular conditions often face poorer outcomes with multiple sclerosis (MS). A recent study aimed to evaluate the burden of age of onset of cardiovascular conditions in a US population with MS, neuromyelitis optica spectrum disorder (NMOSD), or transverse myelitis (TM) and found that cardiovascular conditions are as common in those with demyelinating diseases compared with unaffected individuals.

“MS, NMOSD, and TM are autoimmune, demyelinating diseases of the central nervous system with heterogeneous clinical presentations that adversely impact daily functioning, employment, and quality of life,” explained the study. “These inflammatory, demyelinating conditions do have distinct immunopathogenesis, epidemiology, and clinical phenotypes.”

The researchers recruited patients from the Accelerated Cure Project Repository, an open-access collection of blood-derived biological samples and epidemiologic data from individuals with MS, NMOSD, TM, and other rare demyelinating diseases, as well as unaffected controls. The data collected were then used to compare the burden of self-reported type 2 diabetes, heart disease, hyperlipidemia, and hypertension in individuals with MS, NMOSD, and TM with that among controls. The data were adjusted for demographics, smoking history, obesity, family history of individual cardiovascular conditions, and presence of cardiovascular conditions.

In total there were 1548 MS cases, 306 NMOSD cases, 145 TM cases, and 677 unaffected controls included in the analysis. The main findings revealed that patients with MS were 48% more likely to have ever had hypertension than controls, but this association was independent of established cardiovascular risk factors, such as smoking history and obesity. Additionally, there were no differences in the age of cardiovascular disease onset between cases and control subjects.

“It is also important to acknowledge evidence suggesting hypertension may be a side effect of various disease-modifying therapies,” noted the authors. “Nonetheless, the age of hypertension onset did not differ between all MS cases and controls, which may suggest a modest role for disease modifying therapies on hypertension risk in these MS cases.”

The authors emphasized the need to include comorbidity management as part of care for patients with demyelinating disease, in addition to new collaborative models of care, in order to improve the treatment of patients.

“In summary, this study demonstrates the burden of cardiovascular conditions are similar, in persons with demyelinating diseases as they are in unaffected individuals, with the exception of hypertension being more common in those with MS even after accounting of established cardiovascular risk factors,” concluded the researchers. “Considering prior studies connecting cardiovascular conditions with adverse MS outcomes, one can hypothesize that optimization of cardiac comorbidities may result in a less severe outcomes for those with MS, and by extension NMOSD and TM.”

Reference

Saroufim P, Zweig S, Conway DS, Briggs FBS. Cardiovascular conditions in persons with multiple sclerosis, neuromyelitis optica and transverse myelitis [published online July 10, 2018]. Mult Scler Relat Disord. doi: 10.1016/j.msard.2018.07.011.