Cardiovascular risk factors may contribute to brain atrophy in MS patients

The presence of cardiovascular (CV) risk factors is associated with brain atrophy in MS patients ≤50 years, who are unlikely to have small vessel disease. An Italian cross-sectional observational study suggests CV risk factors have synergistic effects in MS [1].

The impact of CV risk factors on T2 hyperintense lesion volume and brain atrophy in MS patients aged ≤50 years was evaluated in 124 MS patients (relapsing-remitting MS, n=79; progressive MS, n=45) and 95 matched healthy controls. Participants underwent a complete neurological assessment and brain 3D T2-weighted and FLAIR MRI, as well as 3D T1-weighted MRI. Assessed traditional CV risk factors were smoking ≥5 pack-years, hypertension, dyslipidaemia, and (pre-)diabetes. More stringent cut-offs were also assessed: smoking ≥10 pack-years, and hypertension, dyslipidaemia, or diabetes while on medication. Of the 124 MS patients, 48 had 1 traditional CV risk factor, 15 had 2 or more. Of 95 healthy controls, 19 had 1 risk factor, 4 had more (P<0.001). Thirty MS patients had 1 stringent risk-factor, and 8 had more than 1, as did 10 and 3 healthy controls (P=0.01). The most common CV risk factor was smoking.

In MS patients, having 2 or more traditional CV risk factors was associated with reduced normalised grey matter volume (nGMV; P=0.01), white matter volume (nWMV; P=0.03), and whole brain volume (nBV; P=0.003), but not with T2-lesion volume (T2-LV; P=0.27). Only hypertension was associated with MRI measures (nWMV and nBV). Having 1 stringent CV risk factor was associated with reduced nGMV (P=0.006), nWMV (P=0.003), and nBV (P<0.001), and higher T2-LV (P=0.03). In healthy controls, neither traditional nor stringent risk factors significantly impacted the abovementioned measures.

1. Bonacchi R, et al. Cardiovascular risk factors affect brain volume in young MS patients. MSVirtual 2020, Abstract PS04.05.