DMT and risk of heart problems

Brain health is as important to MSers as it is to the normal population. #MSBlog #MSResearch

“This small study looking at cardiovascular risk factors and DMTs has issues that make it impossible to interpret. MSers on DMTs are different to MSers who are naive to treatment; naive MSers are either earlier in the course of their disease, hence younger, or have inactive or benign MS, hence no DMTs. What is interesting is that MSers with cardiovascular risk factors have a worse course. This makes sense in that comorbidities that affect the brain such as hypertension, diabetes, raised cholesterol and smoking affect the reserve capacity of the brain and reduce its ability to compensate for MS-related damage and  normal ageing. Comorbidity accelerating MS-related disease progression has been commented before on this blog and is reasonably well accepted as a poor prognostic predictor by the field.”

“What can we do about this study? I suggest getting card-carrying epidemiologists with access to large insurance and national databases to interrogate their populations. The Scandinavian countries are best positioned to do the latter. At an individual level you need to take your comorbidities seriously and get them under control. To stop smoking get help; smoking is an addiction and you need professional help; I suggest nicotine replacement therapies and behavioral therapy. Start exercising; this is easier said than done, particularly if you are disabled. Discuss exercise with your physiotherapist and see if he/she can help you with a bespoke programme. Get your diet on track and make sure you blood pressure, sugar levels and cholesterol are well controlled. This is all common sense; I refer to it as brain health and is as important to MSers and it is to so called ‘normal people’. Brain health is what will result in us ageing well. MSers get old like most of do.”

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Epub: Sternberg et al. Disease Modifying Therapies Modulate Cardiovascular Risk Factors in Multiple Sclerosis Patients.Cardiovasc Ther. 2013 Oct 1. doi: 10.1111/1755-5922.12049.

OBJECTIVES: This retrospective study aimed to determine (1) The association between the use of three major disease modifying therapies (DMTs) (Interferon-beta (IFN-β), Glatiramer acetate (GA), Natalizumab (NTZ)) and cardiovascular (CV) risk factors in MSers, and (2) The association between the use of CV drugs (antihypertensive, hypolipidemic, antiplatelets) and other drugs acting on the CV system (antispastics/ anticonvulsants/ anxyolitics, antidepressants/ stimulants), and MS disease severity. 

METHODS: The charts of 188 MSers, who were taking one of the three DMTs, and 110 MSers, who were naïve to these drugs, were retrospectively reviewed. The obtained data included height and weight, fasting lipid profiles, plasma glucose, systolic and diastolic BP, smoking habit, list of medications, and indicators of MS disease severity.

RESULTS: The use of DMTs was associated with higher diastolic BP readings, as well as higher plasma glucose and HDL-C plasma levels. In addition, there was an association between CV risk factors and the type of DMTs. Compared to DMT-naïve MSers, the use of IFN-β and GA was associated with higher CV risk factors whereas the use of NTZ was associated with lower CV risk factors. In DMT-naïve MSers, the use of CV and related drugs was associated with higher extended disability status scale (EDSS) and higher MS severity scale (MSSS).

CONCLUSION: There is an association between higher CV risk factors and the use of DMTs. Furthermore, the use of CV and related drugs is associated with MS disease severity. 

About the author

Prof G

Professor of Neurology, Barts & The London. MS & Preventive Neurology thinker, blogger, runner, vegetable gardener, husband, father, cook and wine & food lover.

1 comment

  • This is no surprise. I sat next to a person in a wheelchair that told me he had fought to get beter-interferon. I was shocked at the number of times he left the room throughout the evening to smoke. Also, I know people that are on Statins as they were high risk for heart disease and eat an unhealthy diet. It is difficult to know if lifestyle caused the problems or the DMTs unless this was recorded prior to treatment.

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