Vascular disease among hospitalized multiple sclerosis patients.

Section of Chronic Disease Epidemiology, Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, Conn, USA.
Neuroepidemiology (Impact Factor: 2.48). 02/2008; 30(4):234-8. DOI: 10.1159/000128103
Source: PubMed

ABSTRACT We examined the prevalence of cardiac and cerebrovascular disease among hospitalized patients with and without multiple sclerosis (MS).
This study used the Statewide Planning and Research Cooperate System data set of over 15 million hospitalizations in New York City from 1988 through 2002. We identified MS patients 40-84 years of age who were hospitalized for reasons other than MS or related complications. MS patients were matched 1:2 on age, gender, race/ethnicity, and insurance. Outcomes included a principal discharge diagnosis of ischemic heart disease [International Classification of Diseases, Ninth Revision (ICD-9) 410-414], myocardial infarction (ICD-9 410), and ischemic stroke (ICD-9 434, 436). Multivariate logistic regression was used to compare vascular disease outcomes in MS and non-MS patients controlling for demographic and clinical factors.
Our study included 9,949 hospitalizations among MS patients and 19,898 hospitalizations for matched non-MS controls. MS patients were less likely to be hospitalized for ischemic heart disease (OR = 0.58, 95% CI = 0.51-0.66) or myocardial infarction (OR = 0.78, 95% CI = 0.64-0.96), but more likely to be hospitalized for ischemic stroke (OR = 1.66, 95% CI = 1.33-2.09) than matched non-MS controls.
MS patients have decreased rates of hospital admission for ischemic heart disease and myocardial infarction, but increased rates of hospitalization for ischemic stroke as compared to the general non-MS population.

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    ABSTRACT: Background and purposeCardiovascular disease (CVD) risk amongst multiple sclerosis (MS) patients appears raised, but few studies have examined CVD risk amongst an unselected MS patient group. MS course may be relevant for CVD risk. Our aim was to assess CVD risk and variation by course in MS patients.Methods The Multiple Sclerosis Register identified 7667 patients who received an MS diagnosis between 1964 and 2005. They were matched by age, period, region and sex with 76 045 members of the general population without MS using Swedish registers. Poisson regression compared the two cohorts to estimate the relative risk for CVD, overall, as well as grouped and individual CVD diagnoses.ResultsMS patients had an increased adjusted relative risk (with 95% confidence intervals; number of MS cohort events) for CVD of 1.31 (1.22–1.41; n = 847), with some variation by course: relapsing−remitting 1.38 (1.17–1.62; n = 168); secondary progressive 1.30 (1.18–1.53; n = 405) and primary progressive 1.15 (0.93–1.41; n = 108). The association for the relapsing−remitting course was not significant after excluding the first year of follow-up. Overall incidence rates per 1000 person-years for CVD are 11.8 (11.06–12.66) for the MS cohort and 8.8 (8.60–9.05) for the non-MS cohort. The most pronounced association was for deep vein thrombosis: relapsing−remitting 2.16 (1.21–3.87; n = 14), secondary progressive 3.41 (2.45–4.75; n = 52) and primary progressive 3.57 (1.95–6.56; n = 15). MS was associated with ischaemic stroke but largely during the first year of follow-up. MS was associated with a decreased relative risk for angina pectoris and atrial fibrillation.Conclusions There is a significantly increased relative risk for CVD in MS, particularly for venous thromboembolic disorders in progressive MS, suggesting immobility as a possible factor. An increased frequency of ischaemic stroke in MS is most probably due to surveillance bias resulting from diagnostic investigations for MS. There is no increased relative risk for ischaemic heart disease in MS and atrial fibrillation appears to be less common than amongst the general population.
    European Journal of Neurology 07/2014; · 3.85 Impact Factor
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    ABSTRACT: This retrospective study aimed to determine (1) The association between the use of three major disease modifying therapies (DMTs) (Interferon-beta (IFN-β), Glatiramer acetate (GA), Natalizumab (NTZ)) and cardiovascular (CV) risk factors in multiple sclerosis (MS) patients, and (2) The association between the use of CV drugs (antihypertensive, hypolipidemic, antiplatelets) and other drugs acting on the CV system (antispastics/anticonvulsants/anxyolitics, antidepressants/stimulants), and MS disease severity. Methods The charts of 188 MS patients, who were taking one of the three DMTs, and 110 patients, who were naïve to these drugs, were retrospectively reviewed. The obtained data included height and weight, fasting lipid profiles, plasma glucose, systolic and diastolic BP, smoking habit, list of medications, and indicators of MS disease severity. The use of DMTs was associated with higher diastolic BP readings, as well as higher plasma glucose and HDL-C plasma levels. In addition, there was an association between CV risk factors and the type of DMTs. Compared to DMT-naïve MS patients, the use of IFN-β and GA was associated with higher CV risk factors whereas the use of NTZ was associated with lower CV risk factors. In DMT-naïve patients, the use of CV and related drugs was associated with higher extended disability status scale (EDSS) and higher MS severity scale (MSSS). There is an association between higher CV risk factors and the use of DMTs. Furthermore, the use of CV and related drugs is associated with MS disease severity. This article is protected by copyright. All rights reserved.
    Cardiovascular Therapeutics 10/2013; · 2.85 Impact Factor
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    ABSTRACT: Background Studies suggest an altered risk of ischemic heart disease (IHD) in multiple sclerosis (MS), but data are limited. We aimed to validate and apply administrative case definitions to estimate the incidence and prevalence of IHD in MS. Methods Using administrative data we identified persons with incident MS (MSPOP) and a matched general population (GPOP) cohort. We developed case definitions for IHD using ICD-9/10 codes and prescription claims, compared them to medical records, then applied them to evaluate the incidence and prevalence of IHD. Results Agreement between medical records and the administrative definition using ≥1 hospital or ≥2 physician claims over 5 years was moderate (kappa=0.66; 95% CI: 0.42–0.90). In 2005, the age-standardized prevalence of IHD was 6.77% (95% CI: 5.48–8.07%) in the MSPOP and 6.11% (95% CI: 5.56–6.66%) in the GPOP. The prevalence of IHD was higher in the MSPOP than the GPOP among persons aged 20–44 years (prevalence ratio 1.87; 95% CI: 1.65–2.12) and aged 45–59 years (prevalence ratio 1.21; 95% CI: 1.08–1.35). The incidence of IHD was also higher in the MSPOP (incidence rate ratio 1.24; 95% CI: 0.97–1.59). Conclusions More than 5% of the MSPOP has IHD. The incidence of IHD was higher than expected in persons aged <60 years. Further evaluation of this issue is warranted.
    Multiple Sclerosis and Related Disorders. 10/2013; 2(4):355–361.