Multiple sclerosis and stroke: a systematic review and meta-analysis

Abstract

Background Multiple sclerosis (MS) and stroke are two common causes of death and disability worldwide. The relationship between these two diseases remains unclear. Effective early preventative measures and treatments are available to reduce the morbidity and mortality of acute stroke. The objectives of our systematic review are to estimate the risk of stroke in patients with MS and to collate related studies to draw preliminary conclusions that may improve clinical practice. Method Relevant studies were systematically searched in MEDLINE, Embase, the Chinese Biomedical Literature Database (CBM), the China National Knowledge Infrastructure and the VIP database of Chinese periodicals from January 1983 to May 2017, with no restrictions on language. Patients included in this review were adults who suffered from MS. Review Manager 5.3 software program was used to pool data and calculate the risk ratio (RR) and its 95% confidence interval (CI). We also performed heterogeneity and sensitivity analyses and evaluated bias in the meta-analysis. Results Nine studies including more than 380,000 participants that met our inclusion criteria were incorporated into the meta-analysis. During different follow-up periods, patients with MS had an increased risk of any type of stroke [RR = 3.48, 95% CI (1.59, 7.64), P = 0.002 for 1 year; RR = 2.45, 95% CI (1.90, 3.16), P < 0.00001 for 10–13 years]. The total prevalence of stroke (any type) in patients with MS exceeded expectations compared to different groups [Comparing with general veteran: RR = 2, 95% CI (1.19, 3.38), P = 0.009. Comparing with general population: RR = 2.93, 95% CI (1.13, 7.62), P = 0.03]. Furthermore, ischemic stroke was particularly more common in the MS population than in people without MS [RR = 6.09, 95% CI (3.44, 10.77), P < 0.00001]. Conclusion Compared with the general population, people with MS have an increased risk of developing any type of stroke and ischemic stroke in particular. Consistent results were obtained from patients of different sexes and age groups. Preventative measures and treatments should be administered at earlier time points to improve patient outcomes. Electronic supplementary material The online version of this article (10.1186/s12883-019-1366-7) contains supplementary material, which is available to authorized users.

Increased Pro-Thrombotic Platelet Activity Associated with Thrombin/PAR1-Dependent Pathway Disorder in Patients with Secondary Progressive Multiple Sclerosis

“…Evidence of an increased effect of thrombin in vivo has been found in individuals at high risk of developing clinically significant thromboembolism in both the veins and arteries [ 42 ]. The reports related to vascular disease in MS, confirm an increased risk of ischemic events associated with abnormal coagulation cascade and an over-activity of platelets, especially ischemic stroke, myocardial infarction and venous thromboembolism [ 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 43 ]. A large Danish population-based cohort study revealed that death caused by vascular or cardiac diseases (mainly stroke and deep vein thrombosis) was the most frequently listed reason for death in MS.…”

“…However, there is still a lack of research to explain this phenomenon. Recent meta-analyses and cohort studies concluded that MS is declared to be associated with cardiovascular disease (CVD) due to both thrombin upregulation and blood platelet pro-thrombotic over-activity [ 9 , 10 , 11 ]. Nevertheless, the vast majority of studies that confirmed the platelet abnormalities in MS patients referred only to the initial phase, that is RR MS [ 12 , 13 , 14 ].…”

Comorbidity in Multiple Sclerosis

“…Over an 11-years period, patients with MS had 28% increased risk of acute coronary syndrome, 59% increased risk of cerebrovascular disease, and 32% increased risk of any macrovascular disease, which was not completely accounted for by traditional vascular risk factors (17). According to a recent systematic review and meta-analysis, stroke, and ischemic cerebrovascular event occur more frequently in patients with MS (18), although there is a gap of knowledge regarding the extent of the risk and the etiological association with MS.…”

Association of Multiple Sclerosis Phenotypes with Single Nucleotide Polymorphisms of IL7R, LAG3, and CD40 Genes in a Jordanian Population: A Genotype-Phenotype Study

“…In addition, many showed insignificant MS association with the genes variants. Several studies indicated that genetic variations impact not only the susceptibility of MS but also the disease's clinical course and severity [25,26]. Due to the lack of research studies concerning the association of genetic variants with Jordanian MS patient's clinical data, a total number of 21 SNPs were studied within three genes (rs6897932, rs13188960, rs1494554, rs987107, rs987106, rs3194051, rs1494571, rs11567705, rs6871748, rs969128, and rs1494555 within IL7R; rs2365095, rs1922452, rs951818, rs870849, rs188255, and rs11227 within LAG3; and rs6074022, rs1883832, and rs11086996 within CD40) in 218 MS patients of the Jordanian Arab population.…”