In patients with multiple sclerosis (MS), the diagnosis of cardiovascular disease (CVD) is associated with long-term confirmed disability progression, according to study results presented at the Americas Committee for Treatment and Research in Multiple Sclerosis (ACTRIMS) Forum 2023, held in San Diego, California, from February 23 to 25.
Compared with the general population, individuals with MS have a significantly greater prevalence of developing CVD. Notably, prior studies have reported that the presence of CVDs in patients with MS is linked to increased inflammatory and neurodegenerative pathology. Researchers of the current analysis sought to establish the effect of CVDs on long-term confirmed disability progression in a heterogeneous population of individuals with MS.
A total of 276 patients with MS (29 with clinically isolated syndrome [CIS], 129 with relapsing-remitting MS [RRMS], and 117 with progressive MS [PMS]) were clinically followed for 14.9±3.0 years, with an average of 14.4 clinical visits per patient. A retrospective electronic medical records review was used to determine CVD diagnoses at baseline (ie, hypertension, heart disease, dyslipidemia, diabetes) and/or new CVD diagnoses over the follow-up period.
Disability was established by Neurostatus-certified investigators with use of the Expanded Disability Status Scale (EDSS). CDP was determined if a ≥1.0-point EDSS increase from an EDSS of <5.5, or a ≥0.5-point increase from an EDSS of ≥5.5, was reported, which was sustained on the next clinical visit.
The age-adjusted association between a new CVD diagnosis and longitudinal change was determined with the use of mixed-effect models. The survival time and hazard ratio for future disability progression between individuals with MS who developed new CVD and patients with MS who did not develop new CVD during the follow-up were established with the use of age-adjusted Kaplan-Meier curves and Cox regression.
At follow-up, a total of 184 patients with MS reported ≥1 new CVD diagnosis, whereas 93 individuals with MS did not. In the 183 individuals with newly diagnosed CVD, a significantly shortened time to confirmed disability progression was reported compared with the 93 patients with MS who did not develop new CVD (13.4 years vs 15.2 years, respectively; Mantel-Cox P <.001). This was a sex-independent association.
After significant age (P <.001) and time effects (P <.001), the presence of any CVD diagnosis was linked to significantly higher longitudinal EDSS scores (P =.04). In fact, a significant age-to-CVD interaction (P =.002) suggests that a new CVD diagnosis in older individuals with MS can have a greater impact on EDSS scores.
According to the researchers, a “CVD diagnosis can contribute to a greater and more rapid long-term CDP [confirmed disability progression] in pwMS [people with multiple sclerosis].”
This article originally appeared on Neurology Advisor.
Wicks TR, Jakimovski D, Reeves J, et al. Cardiovascular disease diagnosis is associated with long-term confirmed progression in multiple sclerosis. Presented at: ACTRIMS Forum 2023; February 23-25; San Diego, CA. Poster 096.