TY - JOUR
T1 - Cardiovascular risk factors in secondary progressive multiple sclerosis
T2 - A cross-sectional analysis from the MS-STAT2 randomized controlled trial
AU - Williams, Thomas
AU - John, Nevin
AU - Calvi, Alberto
AU - Bianchi, Alessia
AU - de Angelis, Floriana
AU - Doshi, Anisha
AU - Wright, Sarah
AU - Shatila, Madiha
AU - Yiannakas, Marios C.
AU - Chowdhury, Fatima
AU - Stutters, Jon
AU - Ricciardi, Antonio
AU - Prados, Ferran
AU - MacManus, David
AU - Braisher, Marie
AU - Blackstone, James
AU - Ciccarelli, Olga
AU - Gandini Wheeler-Kingshott, Claudia A. M.
AU - Barkhof, Frederik
AU - Chataway, Jeremy
AU - the UCL MS-STAT2 investigators
AU - Brownlee, Wallace
AU - Wynne, Megan
AU - Hockey, Leanne
AU - Parker, Josephine
AU - Flight, Jennifer
AU - Frost, Chris
AU - Nicholas, Jennifer
AU - Nixon, Stuart
AU - Beveridge, Judy
AU - Chandran, Siddharthan
AU - Connick, Peter
AU - Lyle, Dawn
AU - Galea, Ian
AU - Jarman, Elisabeth
AU - Ford, Helen
AU - Fernandes, Linford
AU - Vinjam, Maruthi
AU - Pavitt, Sue
AU - Sharrack, Basil
AU - Paling, David
AU - Shehu, Abdullah
AU - Arun, Tarunya
AU - Belhag, Mohamed
AU - Pearson, Owen
AU - Ingram, Gillian
AU - Rickards, Christopher
AU - McDonnell, Gavin
AU - Hughes, Stella
AU - Spilker, Cord
AU - Fisniku, Leonora
N1 - Funding Information: The authors thank the participants of the MS-STAT2 trial, together with their families and carers; the wider MS-STAT2 investigator group (see Appendix); and the National Institute for Health and Care Research Biomedical Research Centre at University College London Hospitals for their support. Publisher Copyright: © 2023 The Authors. European Journal of Neurology published by John Wiley & Sons Ltd on behalf of European Academy of Neurology.
PY - 2023/9
Y1 - 2023/9
N2 - Background and purpose: There is increasing evidence that cardiovascular risk (CVR) contributes to disability progression in multiple sclerosis (MS). CVR is particularly prevalent in secondary progressive MS (SPMS) and can be quantified through validated composite CVR scores. The aim was to examine the cross-sectional relationships between excess modifiable CVR, whole and regional brain atrophy on magnetic resonance imaging, and disability in patients with SPMS. Methods: Participants had SPMS, and data were collected at enrolment into the MS-STAT2 trial. Composite CVR scores were calculated using the QRISK3 software. Prematurely achieved CVR due to modifiable risk factors was expressed as QRISK3 premature CVR, derived through reference to the normative QRISK3 dataset and expressed in years. Associations were determined with multiple linear regressions. Results: For the 218 participants, mean age was 54 years and median Expanded Disability Status Scale was 6.0. Each additional year of prematurely achieved CVR was associated with a 2.7 mL (beta coefficient; 95% confidence interval 0.8–4.7; p = 0.006) smaller normalized whole brain volume. The strongest relationship was seen for the cortical grey matter (beta coefficient 1.6 mL per year; 95% confidence interval 0.5–2.7; p = 0.003), and associations were also found with poorer verbal working memory performance. Body mass index demonstrated the strongest relationships with normalized brain volumes, whilst serum lipid ratios demonstrated strong relationships with verbal and visuospatial working memory performance. Conclusions: Prematurely achieved CVR is associated with lower normalized brain volumes in SPMS. Future longitudinal analyses of this clinical trial dataset will be important to determine whether CVR predicts future disease worsening.
AB - Background and purpose: There is increasing evidence that cardiovascular risk (CVR) contributes to disability progression in multiple sclerosis (MS). CVR is particularly prevalent in secondary progressive MS (SPMS) and can be quantified through validated composite CVR scores. The aim was to examine the cross-sectional relationships between excess modifiable CVR, whole and regional brain atrophy on magnetic resonance imaging, and disability in patients with SPMS. Methods: Participants had SPMS, and data were collected at enrolment into the MS-STAT2 trial. Composite CVR scores were calculated using the QRISK3 software. Prematurely achieved CVR due to modifiable risk factors was expressed as QRISK3 premature CVR, derived through reference to the normative QRISK3 dataset and expressed in years. Associations were determined with multiple linear regressions. Results: For the 218 participants, mean age was 54 years and median Expanded Disability Status Scale was 6.0. Each additional year of prematurely achieved CVR was associated with a 2.7 mL (beta coefficient; 95% confidence interval 0.8–4.7; p = 0.006) smaller normalized whole brain volume. The strongest relationship was seen for the cortical grey matter (beta coefficient 1.6 mL per year; 95% confidence interval 0.5–2.7; p = 0.003), and associations were also found with poorer verbal working memory performance. Body mass index demonstrated the strongest relationships with normalized brain volumes, whilst serum lipid ratios demonstrated strong relationships with verbal and visuospatial working memory performance. Conclusions: Prematurely achieved CVR is associated with lower normalized brain volumes in SPMS. Future longitudinal analyses of this clinical trial dataset will be important to determine whether CVR predicts future disease worsening.
KW - cardiovascular risk
KW - comorbidity
KW - multiple sclerosis
KW - progressive multiple sclerosis
KW - secondary progressive multiple sclerosis
UR - http://www.scopus.com/inward/record.url?scp=85162952596&partnerID=8YFLogxK
U2 - https://doi.org/10.1111/ene.15924
DO - https://doi.org/10.1111/ene.15924
M3 - Article
C2 - 37318885
SN - 1351-5101
VL - 30
SP - 2769
EP - 2780
JO - European journal of neurology
JF - European journal of neurology
IS - 9
ER -