Multiple sclerosis (MS) is a disabling disease of the central nervous system affecting more than 120,000 people in the UK. As compared with the general population, individuals with MS have a high level of disability and an increased risk of cardiovascular disease (a general term referring to conditions affecting the heart and blood vessels), because they are more likely to have elevated blood pressure and blood lipids, and to be obese, which are all risk factors for cardiovascular disease. Evaluating the cardiovascular risk of individuals with MS is therefore important, considering that increased cardiovascular risk in individuals with MS is also associated with more rapid disease progression and increased risk of death.
This project aims to improve our understanding of the association between cardiovascular risk factors, occurrence of major cardiovascular events (stroke and heart attack), and risk of disability in MS. Specifically, the project aims to evaluate whether the risk of major cardiovascular events in individuals with MS differs from the general population. The project also has an additional objective that consists in developing and validating a clinical tool to predict the risk of MS-related disability and major cardiovascular events for individuals with MS, suitable to be used by general practitioners and nurses when examining individuals with MS
Cardiovascular risk assessment and management is important in people with multiple sclerosis (PwMS) considering they have a high prevalence of cardiovascular risk factors, have increased risk of macrovascular complications, and cardiovascular risk factors are associated with more rapid disease progression and higher mortality.
This project aims to conduct a population-based retrospective cohort study of individuals with MS matched to controls by age, sex, and general practice to i) calculate trends of prevalence and incidence of MS in England; ii) assess the risk of macrovascular disease and mortality in MS; iii) assess whether in PwMS different levels of cardiovascular risk factors, presence of physical and mental-health co-morbidities, and pharmacological treatments for vascular risk are associated with differences in the risk of macrovascular disease, MS-related disability, and mortality; iv) assess whether PwMS are more frail than matched controls considering; v) test the performance and recalibrate of widely adopted vascular risk algorithms in PwMS as compared to people without MS; vi) develop and internally validate a risk prediction algorithm suitable for use in primary care settings to predict the risk of MS-related disability and macrovascular disease to ultimately tailor intervention strategies, while accounting for Frailty and other comorbidities and potential confounders including therapies for comorbidities.
Multivariable survival hazard models will be employed to assess whether incident rates of macrovascular events differ between individuals with MS and the control population. Specifically, for individuals with MS, a risk prediction algorithm will be developed for each of the following outcomes: occurrence of acute coronary events, occurrence of cerebrovascular events, and vascular mortality. Internal validation of the risk prediction algorithm will be performed using the k-fold method. Findings of this project will aid clinicians in accurately assessing the risk of major vascular events in PwMS, thereby supporting informed decisions regarding management of vascular comorbidity.
- MS cases;
- Acute coronary events (acute myocardial infarction, coronary artery disease, coronary revascularisation procedures);
- Cerebrovascular disease (haemorrhagic and ischaemic stroke);
- Frailty level in PwMS (using the electronic Frailty Index score - eFI);
- All-cause and cardiovascular disease mortality
Raffaele Palladino - Chief Investigator - Imperial College London
Raffaele Palladino - Corresponding Applicant - Imperial College London
Azeem Majeed - Collaborator - Imperial College London
Jeremy Chataway - Collaborator - University College London ( UCL )
Mark Cunningham - Collaborator - Imperial College London
Mekha Mathew - Collaborator - Imperial College London
Ruth Ann Marrie - Collaborator - University of Manitoba
HES Admitted Patient Care;ONS Death Registration Data;Patient Level Index of Multiple Deprivation;Practice Level Index of Multiple Deprivation