Associations between multiple sclerosis and incidence of heart diseases: Systematic review and meta-analysis of observational studies

Rapp, Daniel; Michels, Sebastian; Schöpe, Jakob; Schwingshackl, Lukas; Tumani, Hayrettin; Şenel, Makbule

doi:10.1016/j.msard.2021.103279

Cited by 10 publications

(5 citation statements)

References 42 publications

(71 reference statements)

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“…However, the prevalence was generally higher in males, both in MS and in the general population. Literature data regarding the association of IHD and MS are conflicting [ 35 ]: a recent review finds no increased risk in MS [ 36 ], whereas another study reveals an increased risk of IHD in males with MS under 60 years of age, confirming our results [ 35 ]. IHD in PwMS seems to be linked to an increased risk of complications of the clinical picture and a reduction in survival [ 35 , 37 ].…”

Section: Discussionsupporting

confidence: 87%

Prevalence of chronic comorbidities in people with multiple sclerosis: descriptive study based on administrative data in Tuscany (Central Italy)

et al. 2022

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Objective Chronic comorbidities are common in people with multiple sclerosis (PwMS), thus worsening their prognosis and quality of life, and increasing disease burden. The aim of the present study was to evaluate the prevalence of common comorbidities in PwMS in Tuscany (Central Italy) and to compare it with the general population. Methods The prevalence of comorbidities, including diabetes, chronic obstructive pulmonary disease (COPD), hypertension, stroke, heart failure (HF), cardiac infarction and ischemic heart disease (IHD), was assessed in PwMS and in general population resident in Tuscany, aged > 20 years, using administrative data. Results In total, we identified 8,274 PwMS. Among them, 34% had at least one comorbidity, with hypertension being the most common (28.5%). Comparing PwMS with the general population, PwMS had a higher frequency of hypertension and stroke when considering the whole group, and of diabetes, COPD, and IHD when considering sex and age subgroups. This increased risk was especially evident in the young and intermediate age groups, where multiple sclerosis may play an important role as risk factor for some comorbidities. In PwMS, as well as in the general population, prevalence of chronic diseases was higher in males and increased with age. Conclusions Comorbidities frequently coexist with multiple sclerosis and they may have an impact on this complex disease, from the health, clinical, and socioeconomic points of view. Therefore, a routine screening of chronic comorbidities should be a crucial step in clinical practice, as well as the promotion of healthy lifestyles to prevent the onset and to reduce their burden.

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Section: Discussionsupporting

confidence: 87%

Prevalence of chronic comorbidities in people with multiple sclerosis: descriptive study based on administrative data in Tuscany (Central Italy)

et al. 2022

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Section: Resultsmentioning

confidence: 92%

“…107 Patients with MS are at higher risk of several forms of cardiovascular disease, including myocardial infarction and heart failure. 108 DMF is not associated with cardiovascular AEs such as arrhythmia or hypertension and is unlikely to contribute to cardiovascular morbidity in patients with MS. 109,110 Drug-induced liver injury is a recognized risk for patients receiving DMTs for MS. 111 Alanine transaminase (ALT)/aspartate aminotransferase (AST) elevations have been reported in major trials of most DMTs, including DMF. 25,26,48,50,112,113 With DMF, persistent or severe ALT/AST derangement or discontinuation due to liver toxicity occurred in <1-2% of clinical trial participants.…”

Section: Comorbidities Organ Function and Cancer Riskmentioning

confidence: 92%

Clinical use of dimethyl fumarate in multiple sclerosis treatment: an update to include China, using a modified Delphi method

Gold

Barnett

Chan

et al. 2023

Ther Adv Neurol Disord

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Dimethyl fumarate (DMF) is a widely used oral disease-modifying therapy for multiple sclerosis (MS). Its efficacy and safety profiles are supported by over a decade of experience. Differences exist between Asia and Europe/United States in the prevalence and characteristics of MS; most data for DMF are derived from populations outside Asia. DMF was recently (2021) approved for use in China. The objectives of this review were to evaluate the evidence for DMF’s profile, to provide an update to healthcare providers on current knowledge surrounding its use and to assess the relevance of existing data to use in China. This study used a modified Delphi method based on the insights of a scientific Steering Committee (SC), with a structured literature review conducted to assess the data of DMF. The literature review covered all papers in English (from 01 January 2011 to 21 February 2022) that include ‘dimethyl fumarate’ and ‘multiple sclerosis’, and their MeSH terms, on PubMed, supplemented by EMBASE and Citeline searches. Papers were categorized by topic and assessed for relevance and quality, before being used to formulate statements summarizing the literature on each subject. SC members voted on/revised statements, requiring ⩾80% agreement and ⩽10% disagreement for inclusion. Statements not reaching this level were discussed further until agreement was reached or until there was agreement to remove the statement. A total of 1030 papers were retrieved and used to formulate the statements and evidence summaries considered by the SC members. A total of 45 statements were agreed by the SC members. The findings support the positive efficacy and safety profile of DMF in treating patients with MS. Limited Chinese patient data are an ongoing consideration; however, based on current evidence, the statements are considered applicable to both the global and Chinese populations. DMF is a valuable addition to address unmet MS treatment needs in China. Registration: Not applicable

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“…A Danish cohort study found that patients with MS had an increased risk of heart failure compared to the general population [61], and an increased risk of heart failure associated with MS was confirmed in a recent systematic review and meta-analysis [62]. Coincidently, another recent study using 23 Na MRI reported that patients with heart failure have extremely high levels of tissue sodium storage [63], inferring that increased risk of heart failure in patients with MS could be associated with high tissue sodium storage.…”

Section: Heart Failure and Msmentioning

confidence: 87%

Multiple Sclerosis and Sodium Toxicity: Controversy and Future Directions for Low-Salt Interventions

Brown

2023

Sclerosis

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Salt intake is associated with multiple sclerosis; however, controversial findings that challenge this association rely primarily on methods that do not measure total sodium storage within the body, such as food surveys and urinary sodium excretion. In contrast, tissue sodium concentrations measured with sodium MRI confirm high sodium levels in multiple sclerosis, suggesting a role for sodium toxicity as a risk factor for the disease. Research on demyelination in the central nervous system has identified myelin phase transitions associated with increased salinity, which cause structural instabilities of myelin sheaths and add further evidence implicating sodium toxicity as a causative factor in multiple sclerosis. Inflammatory and immune responses in multiple sclerosis are also related to high sodium intake. In addition, salt is a potential mediating factor associating multiple sclerosis with comorbidities, including systemic lupus erythematosus, rheumatic arthritis, inflammatory bowel disease, and cardiovascular disease. Current confusion exists over classifying dietary sodium intake levels as low, normal, and high, and questions remain over levels of sodium restriction necessary for disease prevention. To reduce multiple sclerosis symptoms and prevent disease progression in patients, future research should investigate low-salt interventions with levels of sodium intake associated with ancestral hunter-gatherer tribes.

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Associations between multiple sclerosis and incidence of heart diseases: Systematic review and meta-analysis of observational studies

Cited by 10 publications

References 42 publications

Prevalence of chronic comorbidities in people with multiple sclerosis: descriptive study based on administrative data in Tuscany (Central Italy)

Prevalence of chronic comorbidities in people with multiple sclerosis: descriptive study based on administrative data in Tuscany (Central Italy)

Clinical use of dimethyl fumarate in multiple sclerosis treatment: an update to include China, using a modified Delphi method

Multiple Sclerosis and Sodium Toxicity: Controversy and Future Directions for Low-Salt Interventions

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