Heart disease associated with atrophy in MS


The University of Buffalo MS group has reported that comorbid cardiovascular disease appears to contribute to more rapid brain tissue loss in patients with multiple sclerosis (Jakimovski et al. Eur J Neurol 2018; epublished August 13, 2018).

The study compared 194 MS patients and 43 healthy controls over a 5-year period. Brain atrophy was evaluated with 3T MRI. MS patients with cardiovascular disease had a higher loss of white matter volume (-4.2% vs. -0.7%) and whole-brain volume (-3.4% vs. -1.6%) compared to MS patients without heart disease.

Cardiovascular risk factors, including hyperlipidemia, smoking and obesity, were not associated with MRI outcomes. However, hypertension was associated with a higher percentage lateral ventricle volume change in MS patients versus normotensive MS patients (24.5% vs. 14.1%). The authors concluded that the presence of cardiovascular disease may contribute to neurodegenerative brain tissue injury in MS patients.

The group previously reported an association between brain atrophy measures and cardiovascular risk factors (Kappus et al. J Neurol Neurosurg Psychiatry 2016;87:181-187). The study prospectively examined brain atrophy in 550 patients with clinically isolated syndrome, RRMS or progressive MS and 175 healthy controls. Smoking (51.7% vs 36.5%) and hypertension (33.9% vs 24.7%) were more common in MS patients compared to healthy controls. Overall, 49.9% of MS patients had 2 or more cardiovascular risk factors (vs. 36.0% of healthy controls); 18.8% had 3 or more CV risk factors (vs. 8.6%). In MS patients, hypertension and heart disease were associated with decreased grey-matter and cortical volumes; obesity was associated with increased T1 lesion volume; and smoking was associated with lower whole-brain volume.

A separate cross-sectional study also examined the relationship between hypertension and brain atrophy in 95 MS patients (Dossi et al. Front Neurol 2018;9:487 ; free full text at www.ncbi.nlm.nih.gov/pmc/articles/PMC6026666/pdf/fneur-09-00487.pdf). Overall, 29.5% of MS patients were normotensive, 52.6% were prehypertensive (SBP 120-139/DBP 80-89) and 17.9% were hypertensive (SBP >140/DBP >90); according to 2017 guidelines, 29% were normotensive, 18% had elevated BP (SBP 120-129/DBP < 80) and 53% were hypertensive (SBP >130/DBP >80).

Increasingly high systolic BP was associated with damage to posterior white-matter tracts and higher levels of grey-matter atrophy, notably in the frontal cortex. Systolic BP was not associated with lesion volume or lesion number. The authors concluded that hypertension is related to changes in white- and grey-matter integrity in MS patients, underscoring the need for ongoing monitoring and control of blood pressure.

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