If you thought having MS was bad enough the Swedish study below confirms that people with MS are more likely to have a raft of other diseases, which include cardiovascular disease (CVD), stroke, heart failure, venous thromboembolism, other autoimmune conditions, bowel dysfunction, depression and fractures. These results replicate what we see from other studies and are not dissimilar what we see in other autoimmune diseases such as rheumatoid arthritis (RA).
It is clear that some comorbidities, in particular, venous thromboembolism, bowel problems, depression and fractures, are probably due to MS. However, the other comorbidities are associated with MS. Why pwMS are at increased risk of CVD, stroke and heart failure is interesting and needs more study. Is it because pwMS live an unhealthy lifestyle; poor diet, less exercise and a higher rate of smoking? Or is the systemic inflammation that occurs in MS driving the vascular disease? Should we be doing trials to test preventive strategies to address this problem? I suspect the answer to all of these questions is YES.
What are the clinical implications of these findings? We know from other studies that pwMS with vascular and other comorbidities become disabled more quickly. A person with MS with vascular comorbidity will on average need a walking stick 6 years earlier than a pwMS who does not have vascular comorbidity. This 6-year gap is larger than the treatment effect of our platform therapies. Six years is a long time in the life of someone with MS.
Therefore, if you want to manage MS holistically pwMS need to be screened for comorbidities and have them managed. This is part of my marginal gains strategy. Who should do the comorbidity screening? In the UK it usually falls to the family doctor or GP to do this screening, but I have found many pwMS simply don’t see their GP regularly enough for health checks. This is why it may be important for you as individuals with MS, and a stake in your own health, to take control and have yourself screened.
More importantly, prevention is better than cure. So if you have MS you should do everything you can to prevent yourself from developing comorbidity. This means adopting a heart- and brain-healthy lifestyle; stop smoking, improving your diet, maintaining a healthy weight, exercising regularly, reducing your alcohol consumption to safe limits, having your blood pressure, cholesterol and sugar levels checked. In addition, you need the inflammation due to your MS controlled; this may require DMTs and a highly-effective DMT.
I am aware this advice is easier said than done, but at the end of the day, there is only so much that your HCP can do and a lot of the advice above is about self-management and empowering yourself to take responsibility for your own health.
Castelo-Branco et al. Non-infectious comorbidity in patients with multiple sclerosis: A national cohort study in Sweden. Mult Scler J Exp Transl Clin. 2020 Aug 14;6(3):2055217320947761.
Background: Comorbidity is of significant concern in multiple sclerosis (MS). Few population-based studies have reported conditions occurring in MS after diagnosis, especially in contemporary cohorts.
Objective: To explore incident comorbidity, mortality and hospitalizations in MS, stratified by age and sex.
Methods: In a Swedish population-based cohort study 6602 incident MS patients (aged ≥18 years) and 61,828 matched MS-free individuals were identified between 1 January 2008 and 31 December 2016, using national registers. Incidence rates (IRs) and incidence rate ratios (IRRs) with 95% CI were calculated for each outcome.
Results: IRs of cardiovascular disease (CVD) were higher among MS patients than MS-free individuals, (major adverse CVD: IRR 1.42; 95% CI 1.12-1.82; hemorrhagic/ischemic stroke: 1.46; 1.05-2.02; transient ischemic attack: 1.65; 1.09-2.50; heart failure: 1.55; 1.15-2.10); venous thromboembolism: 1.42; 1.14-1.77). MS patients also had higher risks of several non-CVDs such as autoimmune conditions (IRR 3.83; 3.01-4.87), bowel dysfunction (2.16; 1.86-2.50), depression (2.38; 2.11-2.68), and fractures (1.32; 1.19-1.47), as well as being hospitalized and to suffer from CVD-related deaths ((1.91; 1.00-3.65), particularly in females (3.57; 1.58-8.06)).
Conclusion: MS-patients experience a notable comorbidity burden which emphasizes the need for integrated disease management in order to improve patient care and long-term outcomes of MS.