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. 2015 Mar;21(3):318-31.
doi: 10.1177/1352458514564485. Epub 2014 Dec 22.

A systematic review of the incidence and prevalence of cardiac, cerebrovascular, and peripheral vascular disease in multiple sclerosis

Ruth Ann Marrie  1 , Nadia Reider  2 , Jeffrey Cohen  3 , Olaf Stuve  4 , Maria Trojano  5 , Gary Cutter  6 , Stephen Reingold  7 , Per Soelberg Sorensen  8
Affiliations

A systematic review of the incidence and prevalence of cardiac, cerebrovascular, and peripheral vascular disease in multiple sclerosis

Ruth Ann Marrie et al. Mult Scler. 2015 Mar.

Abstract

Background: Findings regarding the prevalence of vascular comorbidities in multiple sclerosis (MS) are conflicting.

Objective: The objective of this review is to estimate the incidence and prevalence of vascular comorbidities and predisposing comorbidities in persons with MS and to assess the quality of the included studies.

Methods: The PubMed, EMBASE, SCOPUS and Web of Knowledge databases, conference proceedings, and reference lists of retrieved articles were searched. One reviewer abstracted data using a standardized data collection form, while the second reviewer verified the abstraction. Included studies were assessed qualitatively. Quantitatively, we assessed studies using the I² statistic, and conducted meta-analyses for population-based studies only.

Results: The prevalence of hypertension and hyperlipidemia exceeded 10% in the MS population and increased with age. While the prevalence of ischemic heart disease, congestive heart failure, and stroke were less than 5% overall, the prevalence of these conditions exceeded expectations when compared to the general population. Cardiac valvular disease, however, affected the MS population less often than expected. Problems with study quality were common.

Conclusion: Despite the relatively high prevalence of some vascular comorbidities in the MS population, important gaps exist in our understanding of their epidemiology. Most of our knowledge is based on studies conducted in a small number of regions.

Keywords: Multiple sclerosis; cardiac; comorbidity; incidence; peripheral vascular disease; prevalence; stroke; systematic review.

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Conflict of interest statement

Conflicts of interest: Ruth Ann Marrie receives research funding from: Canadian Institutes of Health Research, Public Health Agency of Canada, Manitoba Health Research Council, Health Sciences Centre Foundation, Multiple Sclerosis Society of Canada, Multiple Sclerosis Scientific Foundation, Rx & D Health Research Foundation, and has conducted clinical trials funded by Sanofi-Aventis.

Nadia Reider has nothing to declare.

Jeffrey Cohen reports personal compensation for consulting from EMD Serono, Genentech, Genzyme, Innate Immunotherapeutics, Novartis, and Vaccinex. He receives research support paid to his institution from Biogen Idec, Consortium of MS Centers, US Department of Defense, Genzyme, US National Institutes of Health, National MS Society, Novartis, Receptos, Synthon, Teva, and Vaccinex.

Olaf Stuve is an associate editor of JAMA Neurology, and he serves on the editorial boards of the Multiple Sclerosis Journal, Clinical and Experimental Immunology, and Therapeutic Advances in Neurological Disorders. He has participated in data and safety monitoring committees for Pfizer and Sanofi. Dr Stuve has received grant support from Teva Pharmaceuticals.

Maria Trojano has served on scientific advisory boards for Biogen Idec, Novartis, and Merck Serono; has received speaker honoraria from Biogen-Idec, Sanofi Aventis, Merck-Serono, Teva, and Novartis; and has received research grants from Biogen-Idec, Merck-Serono, and Novartis.

Gary Cutter has served on scientific advisory boards for and/or received funding for travel from Innate immunity, Klein-Buendel Incorporated, Genzyme, Medimmune, Novartis, Nuron Biotech, Spiniflex Pharmaceuticals, Somahlution, Teva Pharmaceuticals; receives royalties from publishing Evaluation of Health Promotion and Disease Prevention (The McGraw Hill Companies, 1984); has received honoraria from GlaxoSmithKline, Novartis, Advanced Health Media Inc, Biogen Idec, EMD Serono Inc, EDJ Associates Inc, the National Heart, Lung, and Blood Institute, National Institute of Neurological Diseases and Stroke, National Marrow Donor Program, Consortium of Multiple Sclerosis Centers; Mt. Sinai School of Medicine and Teva Pharmaceuticals; and has served on independent data and safety monitoring committees for Apotek, Ascendis, Biogen-Idec, Cleveland Clinic, Glaxo Smith Klein Pharmaceuticals, Gilead Pharmaceuticals, Modigenetech/Prolor, Merck/Ono Pharmaceuticals, Merck, Neuren, PCT Bio, Teva, Vivus, NHLBI (Protocol Review Committee), NINDS, NMSS, NICHD (OPRU oversight committee).

Stephen Reingold reports personal consulting fees from the National Multiple Sclerosis Society (NMSS) and the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS), during the conduct of this work; and over the past three years, personal consulting fees from Bayer HealthCare, Biogen Idec, Coronado Biosciences Inc, the Cleveland Clinic Foundation, Eli Lilly & Company, from EMD Serono and Merck Serono, Genentech, F. Hoffmann-LaRoche, Ironwood Pharmaceuticals Inc, ISIS Pharmaceuticals Inc, Medimmune Inc, Novartis Pharmaceuticals Corporation, Observatoire Français de la Sclérosis en Plaques, Opexa Therapeutics, Sanofi-Aventis, SK Biopharmaceuticals, Synthon Pharmaceuticals Inc, Teva Pharmaceutical Industries, and Fondation pour l’aide à la Recherche sur la Sclérosis en Plaques, for activities outside of the submitted work.

Per Soelberg Sorensen has received personal compensation for serving on scientific advisory boards, steering committees, independent data monitoring boards in clinical trials, or speaking at scientific meetings from Biogen Idec, Merck Serono, Novartis, Genmab, Teva, GSK, Genzyme, Bayer Schering, Sanofi-Aventis and MedDay Pharmaceuticals. His research unit has received research support from Biogen Idec, Merck Serono, Teva, Sanofi-Aventis, Novartis, RoFAR, Roche, and Genzyme.

Figures

Figure 1.
Figure 1.
Forest plot of the prevalence of hyperlipidemia in multiple sclerosis in population-based studies.
Figure 2.
Figure 2.
Forest plot of the prevalence of hypertension in multiple sclerosis in population-based studies.
Figure 3.
Figure 3.
Forest plot of the incidence of atrial fibrillation in multiple sclerosis in population-based studies.
Figure 4.
Figure 4.
Forest plot of the prevalence of ischemic heart disease in multiple sclerosis in population-based studies.
Figure 5.
Figure 5.
Forest plot of the incidence of stroke in multiple sclerosis in population-based studies.
See this image and copyright information in PMC

References

    1. Langer-Gould A, Popat RA, Huang SM, et al. Clinical and demographic predictors of long-term disability in patients with relapsing–remitting multiple sclerosis: A systematic review. Arch Neurol 2006; 63: 1686–1691. - PubMed
    1. Marrie RA, Rudick R, Horwitz R, et al. Vascular comorbidity is associated with more rapid disability progression in multiple sclerosis. Neurology 2010; 74: 1041–1047. - PMC - PubMed
    1. Weinstock-Guttman B, Zivadinov R, Horakova D, et al. Lipid profiles are associated with lesion formation over 24 months in interferon-β treated patients following the first demyelinating event. J Neurol Neurosurg Psychiatry 2013; 84: 1186–1191. - PubMed
    1. Warren SA, Turpin KV, Pohar SL, et al. Comorbidity and health-related quality of life in people with multiple sclerosis. Int J MS Care 2009; 11: 6–16.
    1. Christiansen CF, Christensen S, Farkas DK, et al. Risk of arterial cardiovascular diseases in patients with multiple sclerosis: A population-based cohort study. Neuroepidemiology 2010; 35: 267–274. - PubMed

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