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Patients with MS and existing or new-onset comorbid cardiovascular disease experienced accelerated clinical disability progression over 15-year follow-up.

Findings published in the Journal of the Neurological Sciences of patients with MS and existing or new-onset comorbid cardiovascular disease (CVD) showed an accelerated clinical disability progression over 15-year follow-up.

Patients with MS have a higher frequency of comorbid CVD compared with the general population despite similar prevalence of cardiovascular risk factors. Robert Zivadinov, MD, PhD, and colleagues evaluated the impact of comorbid onset of CVD diagnosis on long-term confirmed disability progression in this patient population.

The study included 276 patients with MS, including 29 patients with clinically isolated syndrome, 130 with relapsing-remitting MS, and 117 with progressive MS. They were clinically followed for an average of 14.9 years, with a mean of 14.4 clinical visits. Retrospective EMR review determined CVD diagnoses at baseline and over the follow-up. Clinical disability progression was determined with at least a 1.0 point Expanded Disability Status Scale (EDSS) increase from EDSS less than 5.5, or at least a 0.5-point increase from 5.5 and above, and was sustained on the following clinical visit.

The study authors found that having an existing or new CVD-onset diagnosis was associated with a significantly shorter time to overall clinical disability progression. This was detected in 213 patients with MS who had an existing (n=28) or developed new onset (n=185) of CVD versus 63 CVD healthy patients with MS over the follow-up (13.4 years versus 15.9 years; Mantel-Cox, P<0.001), independent of baseline age or EDSS score. The CVD diagnosis preceded the clinical disability progression in 103 patients with MS (53.7%), occurred after clinical disability progression in 71 patients with MS (38.4%), and was concurrent in 11 patients with MS (5.9%).

Mixed-effect models adjusted for significant age and time effects indicated that CVD onset significantly increased EDSS score (P=0.04) in older patients with MS. The authors noted that in the patient cohort, sex was not a significant predictor of future disability. The most common CVD diagnosed at follow-up were hypertension (78.4%) and/or hyperlipidemia (53.4%).

Patients with MS who had an existing or new onset of comorbid CVD diagnosis “showed accelerated disability worsening over long-term. However, “there was no temporal relationship between the onset of CVD and CDP [clinical disability progression] within the group that had CVD-onset diagnosis,” Dr. Zivadinov and colleagues wrote.