Do Cardiovascular Risk Factors Contribute to Brain Atrophy in MS?

LOS ANGELES—Hypertension and heart disease may contribute to advanced central and white matter atrophy in patients with multiple sclerosis (MS) over five years, according to a study presented at the 70th Annual Meeting of the American Academy of Neurology.

The findings suggest that management of cardiovascular comorbidities in MS may improve overall long-term disease outcomes, said Dejan Jakimovski, MD, a clinical research fellow at the Buffalo Neuroimaging Analysis Center at the University at Buffalo, New York, and colleagues.

Dejan Jakimovski, MD

Cardiovascular diseases and risk factors are more common in patients with MS, compared with healthy individuals, and cross-sectional studies have linked smoking, hypertension, hyperlipidemia, and heart disease to lesion burden and brain atrophy, the researchers said.

To determine the influence of cardiovascular diseases over five years in a larger number of patients with MS, Dr. Jakimovski and colleagues examined data from 194 patients with MS in a prospective study of cardiovascular, environmental, and genetic risk factors in MS (CEG-MS). Patients in the study underwent clinical evaluation and completed questionnaires about cardiovascular risk factors (ie, hypertension, hyperlipidemia, heart disease, smoking, diabetes, and obesity or overweight status). The researchers assessed T2 and T1 lesion volumes and volumes of whole brain, gray matter, white matter, cortex, and lateral ventricles using 3-T MRI. They used analysis of covariance adjusted for age, sex, and disease duration to detect significant differences between patients with and without cardiovascular risk factors.

The 194 patients with MS (73.7% female; mean age, 46.7) had an average disease duration of 13.6 years, a median baseline Expanded Disability Status Scale (EDSS) score of 2.5, and a median EDSS at follow-up of 3. Mean BMI was 27.6, 14.9% had hypertension, and 9.8% had heart disease.

At baseline, patients with hypertension had larger lateral ventricular volume, compared with patients without hypertension (66.1 mL vs 49.9 mL). Over the follow-up period, the percentage lateral ventricular volume change was significantly greater in patients with hypertension, compared with patients without hypertension (24.5% vs 14.1%). Over the follow-up period, patients with a diagnosis of heart disease had greater white matter volume loss, compared with those without heart disease (–4.2% vs –0.7%).

Hyperlipidemia, diabetes, smoking, and obesity or overweight status were not associated with more severe progression of MRI outcomes. T1- and T2-lesion volume accrual was not associated with cardiovascular risk factors.

—Jake Remaly