Chataway, J

Majeed, A

Marrie, RA

Palladino, R

English

UCL Discovery

Management of vascular risk in people with multiple sclerosis in England: a population-based matched cohort study R. Palladino1,2, R.A. Marrie3,4, A. Majeed1, J. Chataway5 1Imperial College of London, Department of Primary Care and Public Health, London, United Kingdom, 2"Federico II" University of Naples, Department of Public Health, Naples, Italy, 3University of Manitoba, Department of Internal Medicine, Max Rady College of Medicine, Winnipeg, Canada, 4University of Manitoba, Department of Community Health Sciences, Max Rady College of Medicine, Winnipeg, Canada, 5University College of London, Queen Square MS Centre, UCL Queen Square Institute of Neurology, London, United Kingdom Introduction: People with Multiple Sclerosis (PwMS) are at increased cardiovascular risk and have a high prevalence of vascular comorbidities.Stringent management of vascular comorbidities is important given their association with disability progression. Aim: We conducted a population-based matched cohort study to assess vascular risk management in PwMS versus a matched non-MS population. Methods: PwMS diagnosed after 1 Jan 1987 and registered with English general practices were identified from the CPRD database and matched with up to 6 controls by age, sex, and general practice.Clinical data were linked with hospital and mortality data.First MS diagnosis was considered as the index date and a matched index date was assigned to controls. Study baseline was the year of MS diagnosis. We used multivariable linear, logistic, and mixed-effect linear regression models to assess baseline differences in risk factors and co-morbidities, and risk factor changes over time.We compared the risk of hypertension and type 2 diabetes and the probability of reaching management targets over the study period between groups using Cox proportional hazard regression models.Models were adjusted for age, sex, ethnicity (white/non-white), deprivation index, smoking status, BMI, blood pressure, number of primary care visits in the index year, and index year. Results: We matched 12,251 PwMS to 72,572 controls. Baseline age was 44.9 (13.3)years, 70% were female.At baseline PwMS had lower systolic blood pressure (PwMS 125.1mmHg (13.7); controls 125.5mmHg (14.2); β -0.45 95%CI -0.68,-0.22). PwMS also had a lower BMI (25.9 [4.8]) than controls (26.2 [4.2]) (β -0.49 95%CI -0.57,-0.41) but trajectories did not differ over time. Baseline prevalence of type 2 diabetes and hypertension was greater for PwMS versus controls (diabetes 7.2%, 5.0%, OR 1.26 95%CI 1.15, 1.38; hypertension 9.7%, 7.3%, OR 1.07 95%CI 1.06, 1.07). PwMS had an increased incidence of both comorbidities (type 2 diabetes HR 1.25 95%CI 1.10, 1.42; hypertension HR 1.11 95%CI 1.05,1.17). PwMS with hypertension at baseline were 35% more likely to reach the national target for hypertension management over time (HR 1.35 95%CI 1.24, 1.47) than controls.Sex-specific analyses confirmed these findings. Conclusions: As expected PwMS have a greater prevalence and incidence of vascular comorbidities and there is some evidence of better vascular (hypertension)management. Ultimately individualised full multi-vascular risk assessment is needed. Disclosure In the last 3 years, Jeremy Chataway has received support from the Efficacy and Evaluation (EME) Programme, a Medical Research Council (MRC) and National Institute for Health Research (NIHR) partnership and the Health Technology Assessment (HTA) Programme (NIHR), the UK MS Society, the US National MS Society and the Rosetrees Trust. He is supported in part by the National Institute for Health Research, University College London Hospitals, Biomedical Research Centre, London, UK. He has been a local principal investigator for a trial in MS funded by the Canadian MS society. A local principal investigator for commercial trials funded by: Actelion, Biogen, Novartis and Roche; has received an investigator grant from Novartis; and has taken part in advisory boards/consultancy for Azadyne, Biogen, Celgene, Janssen, MedDay, Merck, Novartis and Roche. Ruth Ann Marrie receives research funding from: CIHR, Research Manitoba, Multiple Sclerosis Society of Canada, Multiple Sclerosis Scientific Foundation, Crohn’s and Colitis Canada, National Multiple Sclerosis Society, CMSC, The Arthritis Society and US Department of Defense. She is supported by the Waugh Family Chair in Multiple Sclerosis. Raffaele Palladino and Azeem Majeed have nothing to disclose.  

Management of vascular risk in people with multiple sclerosis in England: a population-based matched cohort study

https://discovery.ucl.ac.uk/10139619/3/Chataway_palladino_et_al_eposter_ECTRIMS2021.pdf

Management of vascular risk in people with multiple sclerosis in England: a population-based matched cohort study

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