What Role Does Tobacco Smoking Play in Multiple Sclerosis Disability and Mortality? A Review of the Evidence

Weston, Mikail; Constantinescu, Cris S.

doi:10.2217/nmt.14.45

Cited by 15 publications

(3 citation statements)

References 54 publications

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“…Unhealthy lifestyle habits including smoking and alcohol abuse are of major importance as well, according to recent reports on their association with disease progression and survival. 3,11 Further studies should elucidate the particular influences of several comorbidities on the course and outcome of MS, which is important for better clinical care of the individual patient, as well as for developing health system optimization strategies.…”

Section: Methodsmentioning

confidence: 99%

Journal Club: Effect of comorbidity on mortality in multiple sclerosis

Karamyan¹,

Sellner²

2016

Neurology

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Journal Club: Effect of comorbidity on mortality in multiple sclerosisMultiple sclerosis (MS) is a chronic demyelinating disease of the CNS estimated to reduce life expectancy by 7-14 years compared to demographically similar groups in the general population.1 While several disease complications pose a potential risk for mortality, results from large observational studies suggest that comorbidities substantially influence survival in MS. 2,3 In a recent Neurology ® article, Marrie et al. 4 applied an effective methodologic approach to assess the contribution of comorbidity to excess mortality in the MS population. Besides its considerable epidemiologic merit, the study has important implications for the management of patients with MS, particularly if closer surveillance and targeted interventions may reduce the burden of comorbidity among them and improve survival. performed a retrospective matched cohort study using population-based administrative data. The authors stratified cohorts by birth year in order to study temporal changes in survival, hypothesizing that the latter improves in the MS population over time. They also hypothesized that comorbidity shortens the survival of persons with MS. Cox regression analysis employed for statistical analysis provides us with a thorough insight into the effect of multiple covariates on the time to death, whereas some other studies traditionally use logistic regression, which estimates the probability of binary survival response (died vs alive) over the period of observation. An alternative method with time-to-event outcome is the log-rank test, which does not allow adjustment for confounding factors. 5METHODS The authors combined data extracted from 2 data sources. The first was administrative (health) data from the province of Manitoba, Canada, covering 98% of the population. The second data source was the Manitoba Vital Statistics Death Database, encompassing information on all deaths in Manitoba, including date and cause of death classified according to ICD-9 or ICD-10, depending on the time period. Using a validated administrative case definition, the authors identified all MS cases and up to 5 controls for each case, matched on sex, exact year of birth, and region of residence, from April 1, 1984, to March 31, 2012 To analyze the survival in both populations, the authors used univariate Cox regression with age as the time scale. Unlike the standard approach of using time on study as the time scale in a Cox regression (which means estimating time from entry into the study until the event of interest, typically death), and adjusting the model for age, this alternative approach to use age as the time scale allows a straightforward adjustment for multiple effects of aging process, and is recommended for analyzing epidemiologic cohort data. 6 On the other hand, the authors addressed a common source of bias in applications of survival analysis known as left truncation, which occurs when the individuals who have already passed the event of interest prior to study...

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Section: Methodsmentioning

confidence: 99%

Journal Club: Effect of comorbidity on mortality in multiple sclerosis

Karamyan¹,

Sellner²

2016

Neurology

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“…Clinicians should be aware of this interplay when managing MS symptoms. Promoting smoking cessation as part of a secondary and tertiary management strategy is, however, vital since smoking has been shown to play a significant role in disease progression ( 33 ), although this may be more difficult in people experiencing pain or depression.…”

Section: Discussionmentioning

confidence: 99%

Pain in People with Multiple Sclerosis: Associations with Modifiable Lifestyle Factors, Fatigue, Depression, Anxiety, and Mental Health Quality of Life

et al. 2017

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BackgroundPeople with multiple sclerosis (MS) often experience pain, which can interfere with mobility, employment, and quality of life (QOL).MethodsThis cross-sectional study explored associations between pain, demographic, disease, and modifiable lifestyle factors in an international sample of people with MS recruited online.ResultsSubstantial pain, of moderate/severe intensity and interfering at least moderately with work/household or enjoyment of life in the past 4 weeks, was reported by 682/2,362 (28.9%). Substantial pain was associated with fatigue (odds ratio (OR): 6.7, 95% confidence interval (CI): 4.9,9.3), depression (OR:4.0, 95% CI:3.2,5.1), anxiety (OR:2.4, 95% CI:1.9,2.9), and lower mental health QOL (Mean Difference: −14.7, 95% CI:−16.6,−12.8). Regression analyses showed that smoking (OR: 2.0, 95% CI:1.35,2.87) and obesity (OR:2.1, 95% CI: 1.5,2.8), moderate alcohol use (OR: 0.7, 95% CI:0.5,0.9), moderate (OR 0.7, 95% CI: 0.55,0.98) or high (OR 0.6, 95% CI: 0.4,0.8) physical activity level, and healthy diet (OR 0.8, 95% CI: 0.75,0.95, per 10 points) were associated with substantial pain.ConclusionOur results show clear associations with modifiable lifestyle factors and substantial pain in MS. These factors are already considered in the prevention and management of pain in other populations but have not previously been considered in MS. Conversely, pain and associated common MS comorbidities, such as depression, anxiety, and fatigue, may hamper efforts to start or maintain healthy behaviors. Strategies to overcome these barriers need to be considered. Further research should clarify the direction of these associations.

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“…Cigarette compounds, such as nicotine and tobacco, cause this problem in the immune system. Researchers have shown that nicotine increases blood flow in the cerebral capillaries and increases the penetration of the solution into the blood brain barrier, and ultimate leakage from the blood brain barrier is suggested to be a factor in the development of MS 31,32 . Another possibility is that some compounds in cigarettes may have direct toxic effects on the central nervous system and cause myelin loss of neurons 33 .…”

Section: Smokingmentioning

confidence: 99%

Can environmental factors increase the risk of multiple sclerosis? A narrative review

Naghshineh¹,

Hojjati²,

Khatir³

et al. 2019

Biomed. Res. Ther.

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History• ABSTRACT Multiple sclerosis (MS) is one of the most common neurological disorders, which causes nontrauma in young adults in many countries. An important symptom of a disease is the presence of plaque in the brain or the spinal cord, which includes a demyelination region along with relative preservation of axons that may vary in acute and chronic stages. This review was conducted using related keywords through searching in scientific databases. Assessing the related papers showed that in general, MS is recognized as an autoimmune disease with genetic background caused by uncertain environmental factors. Epidemiological effects based on race, sex, geographical location are strongly linked to the frequency, types and severity of the disease. Vitamin D, infection, smoking and diet have been reported to be potential factors associated with MS. Due to the importance of these factors in MS disease, the control of them is potentially useful to prevent the disease and the rapid progression and exacerbation of its symptoms.

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What Role Does Tobacco Smoking Play in Multiple Sclerosis Disability and Mortality? A Review of the Evidence

Cited by 15 publications

References 54 publications

Journal Club: Effect of comorbidity on mortality in multiple sclerosis

Journal Club: Effect of comorbidity on mortality in multiple sclerosis

Pain in People with Multiple Sclerosis: Associations with Modifiable Lifestyle Factors, Fatigue, Depression, Anxiety, and Mental Health Quality of Life

Can environmental factors increase the risk of multiple sclerosis? A narrative review

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