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Meta-Analysis
. 2024 Jul;271(7):4075-4085.
doi: 10.1007/s00415-024-12331-2. Epub 2024 Apr 4.

Prevalence and epidemiology of stroke in patients with multiple sclerosis: a systematic review and meta-analysis

Maria-Ioanna Stefanou  1 , Vasileios Giannopapas  1 , Dimitrios K Kitsos  1 , Maria Chondrogianni  1 , Aikaterini Theodorou  1 , Maria Kosmidou  2 , Pinelopi Vlotinou  3 , Christos Bakirtzis  4 , Elizabeth Andreadou  5 , John S Tzartos  1 , Sotirios Giannopoulos #  6 , Georgios Tsivgoulis #  1
Affiliations
Meta-Analysis

Prevalence and epidemiology of stroke in patients with multiple sclerosis: a systematic review and meta-analysis

Maria-Ioanna Stefanou et al. J Neurol. 2024 Jul.

Abstract

Background: Epidemiological data are sparse regarding the risk of stroke in patients with multiple sclerosis (MS).

Objective: To estimate the following: (1) the pooled prevalence of all-cause stroke, acute ischaemic stroke (AIS) and intracerebral haemorrhage (ICH) in MS patients; (2) the relative risk for all-cause stroke, AIS and ICH in MS patients compared to the general population; (3) associations between patient characteristics and the risk for AIS and ICH in MS patients.

Methods: Systematic review and meta-analysis of registry-based and cohort studies.

Results: Thirteen observational studies comprising 146,381 MS patients were included. The pooled prevalence of all-cause stroke was 2.7% (95% confidence interval [CI] 1.3-4.6%), with the relative risk of all-cause stroke being higher in MS patients compared to the general population (RR: 2.55; 95% CI 1.97-3.29). Subgroup analyses per stroke subtype revealed a pooled AIS prevalence of 2.1% (95% CI 0.8-4.1%) and a pooled ICH prevalence of 0.6% (95% CI 0.2-1.2%). Compared to the general population, patients with MS were found to harbour an increased risk for AIS (RR: 2.79; 95% CI 2.27-3.41) and ICH (RR: 2.31; 95% CI 1.04-5.11), respectively. The pooled prevalence of cardiovascular risk factors in MS patients was 11.5% (95% CI 2.9-24.7%) for dyslipidaemia, 18.2% (95% CI 5.9-35.3%) for hypertension and 5.4% (95% CI 2.1-10.2%) for diabetes. In meta-regression, age was negatively associated with AIS risk (β = - .03, p = 0.04), with a 1-year increase in age resulting in a significant 3% (95%CI 0-5) attenuation of the risk of AIS.

Conclusion: The findings of the present meta-analysis indicate that MS is associated with an increased risk for ischaemic and haemorrhagic stroke. Future well-designed epidemiological studies are warranted to corroborate the robustness of the present findings in the MS population.

Keywords: Cardiovascular risk factors; Cerebrovascular disease; Intracerebral haemorrhage; Multiple sclerosis; Stroke.

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Conflict of interest statement

Dr. Stefanou—nothing to report. Dr. Giannopapas—nothing to report. Dr. Kitsos—nothing to report. Dr. Chondrogianni—nothing to report. Dr. Theodorou—nothing to report. Dr. Kosmidou—nothing to report. Dr. Vlotinou—nothing to report. Dr. Bakirtzis—nothing to report. Dr. Andreadou—nothing to report. Dr. Tzartos—nothing to report. Dr. Giannopoulos—nothing to report. Dr. Tsivgoulis—nothing to report.

Figures

Fig. 1
Fig. 1
Prisma flow chart of included studies
Fig. 2
Fig. 2
Pooled prevalence of all-cause stroke in MS patients
Fig. 3
Fig. 3
Risk ratio of all-cause stroke in the MS population compared to the general population
Fig. 4
Fig. 4
Pooled prevalence of acute ischaemic stroke (AIS) in the MS population
Fig. 5
Fig. 5
Risk ratio of acute ischaemic stroke (AIS) in the MS population compared to the general population
Fig. 6
Fig. 6
Pooled prevalence of intracerebral haemorrhage (ICH) in the MS population
Fig. 7
Fig. 7
Risk ratio of intracerebral haemorrhage (ICH) in the MS population compared to the general population
See this image and copyright information in PMC

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