Department of Primary Care and Public Health, School of Public Health, Imperial College of London, London, UK/Department of Public Health, Federico II University, Naples, Italy.
Departments of Medicine and Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
Mult Scler. 2023 May;29(6):671-679. doi: 10.1177/13524585231164296. Epub 2023 Apr 7.
Vascular management in People with Multiple Sclerosis (PwMS) is important given the higher vascular burden than the general population, associated with increased disability and mortality.
We assessed differences in the prevalence of type 2 diabetes and hypertension; and the use of antidiabetic, antihypertensive and lipid-lowering medications at the time of the MS diagnosis.
This is a population-based study including PwMS and matched controls between 1987 and 2018 in England.
We identified 12,251 PwMS and 72,572 matched controls. PwMS had a 30% increased prevalence of type 2 diabetes (95% confidence interval (CI) = 1.19, 1.42). Among those with type 2 diabetes, PwMS had a 56% lower prevalence of antidiabetic usage (95% CI = 0.33, 0.58). Prevalence of hypertension was 6% greater in PwMS (95% CI = 1.05, 1.06), but in those with hypertension, usage of antihypertensive was 66% lower in PwMS (95% CI = 0.28, 0.42) than controls. Treatment with lipid-lowering medications was 63% lower in PwMS (95% CI = 0.54, 0.74). PwMS had a 0.4-mm Hg lower systolic blood pressure (95% CI = -0.60, -0.13). 3.8% of PwMS were frail.
At the time of diagnosis, PwMS have an increased prevalence of vascular risk factors, including hypertension and diabetes though paradoxically, there is poorer treatment. Clinical guidelines supporting appropriate vascular assessment and management in PwMS should be developed.
多发性硬化症（MS）患者的血管管理很重要，因为其血管负担比一般人群更高，与残疾和死亡率增加相关。
我们评估了 MS 诊断时 2 型糖尿病和高血压的患病率差异；以及使用抗糖尿病、抗高血压和降血脂药物的情况。
这是一项基于人群的研究，纳入了 1987 年至 2018 年期间英格兰的 MS 患者和匹配对照者。
我们共确定了 12251 例 MS 患者和 72572 例匹配对照者。MS 患者的 2 型糖尿病患病率增加了 30%（95%置信区间[CI]：1.19，1.42）。在患有 2 型糖尿病的患者中，MS 患者抗糖尿病药物使用率降低了 56%（95%CI：0.33，0.58）。MS 患者的高血压患病率高 6%（95%CI：1.05，1.06），但患有高血压的患者中，MS 患者抗高血压药物使用率降低了 66%（95%CI：0.28，0.42），而对照者的使用率为 66%。MS 患者使用降脂药物的比例降低了 63%（95%CI：0.54，0.74）。MS 患者的收缩压低 0.4mmHg（95%CI：-0.60，-0.13）。3.8%的 MS 患者身体虚弱。
在诊断时，MS 患者的血管危险因素患病率增加，包括高血压和糖尿病，但令人费解的是，他们的治疗情况较差。应该制定支持 MS 患者进行适当血管评估和管理的临床指南。
