Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA.
Jacobs Comprehensive MS Treatment and Research Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA.
J Neurol Sci. 2024 Sep 15;464:123156. doi: 10.1016/j.jns.2024.123156. Epub 2024 Jul 29.
People with multiple sclerosis (pwMS) have greater prevalence of comorbid cardiovascular diseases (CVD) when compared to the general population despite similar frequency of CV risk factors.
Determine the impact of comorbid-onset of CVD diagnosis on long-term confirmed disability progression (CDP).
276 pwMS (29 clinically isolated syndrome, 130 relapsing-remitting and 117 progressive) were clinically followed an average of 14.9 years, with a mean of 14.4 clinical visits. Retrospective electronic medical records (EMR) review determined CVD diagnoses (hypertension, hyperlipidemia, diabetes, and heart disease) at baseline and over the follow-up. CDP was determined with ≥1.0 point Expanded Disability Status Scale (EDSS) increase from EDSS <5.5, or ≥ 0.5-point increase from ≥5.5, and was sustained on next clinical visit.
A significantly shorter time to overall CDP was detected in 213 pwMS who had an existing (28 pwMS) or developed new onset (185 pwMS) of CVD, compared to 63 CVD-healthy pwMS over the follow-up (13.4 vs 15.9 years, Mantel-Cox p < 0.001), independent of baseline age and EDSS score. The CVD diagnosis preceded the CDP in 103 pwMS (55.7%), occurred after CDP in 71 pwMS (38.4%) and was concurrent in 11 pwMS (5.9%). Using mixed-effect models adjusted for significant age (F = 56.5, p < 0.001) and time effects (F = 67.8, p < 0.001), the CVD-onset diagnosis was associated with greater accrual of disability, as measured by longitudinal increase in EDSS score (F = 4.207, p = 0.04). Sex was not significant predictor of future disability in our cohort.
PwMS with an existing or new onset of comorbid CVD diagnosis showed accelerated disability worsening over long-term. There was no temporal relationship between the onset of CVD and CDP within the group that had CVD-onset diagnosis.
与普通人群相比，多发性硬化症（MS）患者尽管心血管风险因素的频率相似，但合并心血管疾病（CVD）的患病率更高。
确定合并 CVD 诊断对长期确诊残疾进展（CDP）的影响。
276 名 MS 患者（29 例临床孤立综合征、130 例复发缓解型和 117 例进展型）平均临床随访 14.9 年，平均随访 14.4 次。回顾性电子病历（EMR）回顾确定基线和随访期间的 CVD 诊断（高血压、高脂血症、糖尿病和心脏病）。CDP 通过扩展残疾状况量表（EDSS）≥1.0 点从 EDSS <5.5 增加或从≥5.5 增加≥0.5 点确定，并在下一次临床就诊时持续存在。
在 213 名患有合并 CVD（28 名 MS 患者）或新发 CVD（185 名 MS 患者）的 MS 患者中，与 63 名 CVD 健康的 MS 患者相比，整体 CDP 的时间明显缩短，在随访过程中（13.4 岁 vs 15.9 岁，Mantel-Cox p <0.001），与基线年龄和 EDSS 评分无关。在 103 名 MS 患者（55.7%）中，CVD 诊断先于 CDP，在 71 名 MS 患者（38.4%）中，CVD 诊断晚于 CDP，在 11 名 MS 患者（5.9%）中，CVD 诊断与 CDP 同时发生。使用调整了显著年龄（F = 56.5，p <0.001）和时间效应（F = 67.8，p <0.001）的混合效应模型，CVD 发病诊断与残疾的累积程度有关，表现为 EDSS 评分的纵向增加（F = 4.207，p = 0.04）。在我们的队列中，性别并不是未来残疾的显著预测因素。
患有合并 CVD 诊断的 MS 患者在长期随访中显示出残疾恶化加速。在患有 CVD 发病诊断的组中，CVD 发病与 CDP 之间没有时间关系。
