Abstract
Objective: To investigate whether cardiovascular (CV) risk factors contribute to accelerated lesion accumulation and brain atrophy development over 5 years in multiple sclerosis (MS) patients.
Background: CV risk factors are more frequently observed in MS patients compared to healthy individuals. Particularly, smoking, hypertension, hyperlipidemia, and heart disease have been linked to higher accumulation of lesion burden and more advanced brain atrophy in cross-sectional studies.
Design/Methods: One hundred and ninety four (n=194) MS patients, part of the Cardiovascular, Environmental and Genetic (CEG) study, were followed longitudinally for 5 years. Full clinical evaluation and a structured questionnaire investigating CV risk factors (hypertension, hyperlipidemia, heart disease, smoking, diabetes, obesity/overweight) were collected. T2- and T1- lesion volumes (LVs), and volumes of whole brain (WBV), gray matter (GMV), white matter (WMV), cortex (CV) and lateral ventricles (LVV) were assessed on 3T MRI examination. No MRI-related hardware or software changes occurred over the follow-up. Analysis of covariance (ANCOVA), adjusted for age, sex, and disease duration, were used for detecting significant differences between MS patients with and without CV risk factors.
Results: MS patients with hypertension had larger LVV when compared to those without (66.1 ml vs. 49.9 ml, p=0.015) at baseline. Over the follow-up period, the percentage LVV change of MS patients with hypertension was significantly higher compared to non-hypertensive patients (24.5% vs. 14.1%, p=0.009). Over the follow-up, patients with a diagnosis of heart disease showed more WMV loss compared to those without (−4.2% vs. 0.7%, p=0.002). Hyperlipidemia, diabetes, smoking or obesity/overweight were not associated with more severe progression of MRI outcomes. No associations between T1- nor T2-LV measures and CV risk factors were detected over 5 years.
Conclusions: Hypertension and heart disease contribute to advanced central and WM atrophy in MS patients. Management of cardiovascular comorbidities in MS may improve the overall long-term disease outcome.
Study Supported by:
The study was partially funded by Jaquemin Foundation and Anette Funicello Research Foundation.
Disclosure: Dr. Jakimovski has nothing to disclose. Dr. Gandhi has nothing to disclose. Dr. Paunkoski has nothing to disclose. Dr. Bergsland has nothing to disclose. Dr. Hagemeier has nothing to disclose. Dr. Ramasamy has nothing to disclose. Dr. Hojnacki has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with David Hojnacki has received speaker honoraria and consultant fees from Biogen Idec, Teva Pharmaceutical Industries Ltd., EMD Serono, Pfizer Inc, and Novartis. Dr. Kolb has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Channa Kolb has received speaker honoraria and consultant fees from EMD Serono, Teva Pharmaceuticals, Acorda, Novartis, Genzyme and Biogen-Idec. Dr. Weinstock-Guttman has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Bianca Weinstock- Guttman received honoraria as a speaker and as a consultant for Biogen Idec, Teva Pharmaceuticals, EMD Serono, Genzyme&Sanofi, Novartis and Acorda. Dr. Weinstock-Guttman has received research support from Dr Weinstock-Guttman received research funds from Biogen Idec, Teva Pharmaceuticals, EMD Serono, Genzyme&Sanofi, Novartis, Acorda. Dr. Zivadinov has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Robert Zivadinov received personal compensation from EMD Serono, Genzyme-Sanofi, Claret Medical, Celgene and Novartis for speaking and consultant fees. Dr. Zivadinov has received research support from RZ received financial support for research activities from Genzyme-Sanofi, Novartis, Claret Medical, Intekrin-Coherus and Quintiles IMS.
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