#T4TD vascular comorbidities

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Did you know if you have MS and vascular comorbidity you are likely to need a walking stick approximately 6 years earlier than if you did not have vascular comorbidity?  Importantly this 6-year difference in reaching EDSS 6.0 (requiring a walking stick) is larger than the treatment effect of a platform DMT.

As vascular comorbidities are largely preventable are you doing anything to prevent or optimally treat your own comorbidities? If not, you need to ask yourself why not? Self-management and taking responsibility for your own health is the order of the day; this has become the new normal. 

Vascular comorbidities = diabetes, hypertension, heart disease, hypercholesterolemia, peripheral vascular disease and smoking.

#T4TD = Thought for the Day

CoI: none for this post

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.

8 comments

  • “Vascular comorbidities speed up MS disease progression”

    Any idea why? Is it the case for all “categories” of MS – RRMS, SPMS, PPMS?

    Does it also hold true for other progressive brain diseases – dementia, Parkinson’s…

    • Vascular comorbidities help shred your reserves and yes is almost certainly holds true for all neurodegenerative diseases.

      • Brain and cognitive reserve are essential to allow normal ageing; you need to do everything you can to protect them.

  • Quantitative MRI in Multiple Sclerosis Patients with Hypertension

    Objective:
    To examine the impact of hypertension on quantitative magnetic resonance imaging (MRI) measures in multiple sclerosis (MS).
    Background:
    Cardiovascular comorbidities, including hypertension, are common in MS and are associated with worse outcomes.
    Design/Methods:
    We conducted a cross-sectional analysis of all patients who underwent quantitative MRI at our center from June 2015 – August 2019. Brain MRIs were quantitatively analyzed via a fully-automated method to calculate T2 lesion volume (T2LV), brain parenchymal fraction (BPF), and spinal cord area (SCA). Our electronic medical record (Epic) was queried to determine the number of hypertension diagnosis codes entered for each patient. Those with ≥2 entries were considered to have hypertension. Univariable and multivariable linear regression models were used to determine the relationship between hypertension and quantitative MRI metrics.
    Results:
    We identified 918 patients who underwent quantitative MRI, of whom 126 had hypertension. The average age among hypertensives was 52.2 years with average disease duration of 17.2 years. Those without hypertension had an average age and disease duration of 45.1 years and 13.3 years respectively. On univariable analysis, patients with hypertension had BPF that was 1.4% lower (p<0.0001), T2LV that was 7.5 mL greater (p<0.0001), and SCA that was 1.8 mm2 less (p=0.05) than those without hypertension. After adjusting for age, hypertension was still significantly associated with T2LV (p=0.0005), but not BPF (p=0.15) or SCA (p=0.4). When adjusting for age, disease duration, MS phenotype, sex, and race, there were no significant associations with hypertension.
    Conclusions:
    Hypertension was associated with greater T2LV, even after controlling for age, suggesting this comorbidity is an important mediator of disease activity. When adjusting for additional clinical factors, hypertension was not associated with our MRI measures suggesting its effects may be mediated through one of our covariates. Additional analysis is needed to determine if chronic small vessel disease contributes to higher T2LV in hypertensive patients.

    Aaan 2020

    https://index.mirasmart.com/AAN2020/PDFfiles/AAN2020-004139.html

    Nice post

  • Hi Pro G. Can you explain what these are hypercholesterolemia, peripheral vascular disease

    I get very frustrated as I do all the things recommended for weight and fitness. Despite not walking well or far I keep my weight in check. I tell myself I might be worse if I hadn’t focused on lifestyle as everyday I exercise to my ability. Most of my effort goes in to keeping as well as possible. It’s a challenge. I can see why people slide. I’m 58. 20 years diagnosed suspected 2 decades before unrecognised as I was super fit.

    • hypercholesterolemia = high cholesterol
      peripheral vascular disease = blockages in the arteries supplying blood to the limbs and organ systems outside the heart (cardiovascular disease) and brain (cerebrovascular disease). The pathology is presumed to be atheroma, which is the same pathology that causes myocardial infarctions and strokes.

      • Thank you. This makes sense. My father has myocardial infarctions. Also mixed dementia. It’s a constant reminder to me of the outcome of less healthy lifestyle choices.

  • Do we know if there is causation or just correlation (half of these come with obesity and lack of exercise)? I’m already on of rosuvastatin and ezetimib due to familial hypercholosterimia, but cholesterol is still a bit higher than it should be. Do I need to discuss this with my doctor?

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