Chataway, J

Majeed, A

Marrie, RA

Palladino, R

English

UCL Discovery

Title: Evaluating the risk of macrovascular events and mortality in individuals with multiple sclerosis in England: a population-based nested case-control study  Authors: R. Palladino1,2, R.A. Marrie3,4, A. Majeed5, J. Chataway6  Affiliations:  1. Primary Care and Public Health, Imperial College of London, London, United Kingdom,  2. Public Health, Federico II University, Naples, Italy,  3. Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences,  4. Internal Medicine and Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada,  5. Primary Care and Public Health, Imperial College, 6Queen Square MS Centre, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, United Kingdom  Abstract  Background: Individuals with Multiple Sclerosis (MS) are at increased cardiovascular risk and mortality; however, evidence from population-based studies is sparse. We assessed whether the risk of macrovascular events and mortality differs in individuals with MS as compared with a matched non-MS population in England. Methods: Individuals with a diagnosis of MS after 1 Jan 1987 and registered with English general practices were identified from the UK Clinical Practice Research Datalink database and matched with up to 6 controls by age, sex, and general practice. Clinical data were linked with hospital and mortality data. We included individuals with ≥3 MS diagnoses recorded over the study period (in primary and secondary care settings). First MS diagnosis was considered as index date and a matched index date was assigned to controls. Study baseline was the year of MS diagnosis. We used multivariable Cox proportional hazard regression model to compare the risk of acute coronary events and cerebrovascular disease and mortality between individuals with a without MS. Models were adjusted for age, sex, ethnicity (white/non-white), deprivation index, smoking status, diabetes, depression, urinary-tract infection, medication (antihypertenshive, lipid-lowering, antidiabetic, anti-platelet, and anti-coagulant), and number of primary care visits in the index year. Results: 12,251 individuals with MS were matched to 72,573 controls. Individuals with MS were younger (42.0 years ± 13.0, controls: 44.9 ± 13.3) than controls, more likely to smoke (38.3% vs. controls: 29.6%), have diabetes (6.9% vs. controls: 5.0%), and depression (20.9% vs. controls: 8.7%); 93.9% were white (controls: 91.8%). They were similar to controls for sex, index of deprivation, and medications. As compared with controls, individuals with MS had increased rates of incident acute coronary events (HR 1.25, 95%CI 1.07-1.47) and cerebrovascular disease (HR 1.81, 95% CI 1.51-2.16). Rate of any macrovascular event was 34% increased (HR 1.34, 95% CI 1.16-1.53). They also had >3-fold increased risk of mortality (HR 3.19, 95% CI 3.03-3.36) and 91% increased risk of fatal macrovascular event (HR 1.92, 95% CI 1.68-2.19). Conclusions: Individuals with MS are at increased risk of macrovascular events and cardiovascular disease mortality; the risk persists after adjusting for cardiovascular risk factors. Further studies are warranted to assess the effect of tight cardiovascular risk factor management on these outcomes.   Disclosure: RP: nothing to disclose. RAM: Ruth Ann Marrie receives research funding from CIHR, the NMSS, MS Society of Canada, CMSC, Crohn's and Colitis Canada and the Waugh Family Chair in Multiple Sclerosis. AM: nothing to disclose. JC: Jeremy Chataway has received funding from the National Institute for Health Research University College London Hospitals Biomedical Research Centre for this work 

82 Evaluating the risk of macrovascular events and mortality in individuals with multiple sclerosis in England: a population-based nested case-control study

https://discovery.ucl.ac.uk/id/eprint/10091438/3/Chataway_Evaluating%20the%20risk%20of%20macrovascular%20events%20and%20mortality%20in%20individuals%20with%20multiple%20sclerosis%20in%20England_AAM.pdf

82 Evaluating the risk of macrovascular events and mortality in individuals with multiple sclerosis in England: a population-based nested case-control study

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