Risk of vascular disease in patients with multiple sclerosis: a review

Objective: Vascular dysfunction and shared risk factors may lead to an increased risk of arterial and venous vascular disease in patients with multiple sclerosis (MS). The aim of this review was to describe studies examining the risk of vascular diseases in MS patients. Methods: A PubMed search combined with review of reference lists and table of contents revealed eight relevant studies describing the occurrence or risk of one or more vascular diseases. Results: One cohort study and three cross-sectional studies described stroke occurrence in 898 to 13 963 MS patients. MS was associated with an increased risk of stroke and cerebrovascular diseases compared with the general population and other hospitalized patients, particularly within the first years after MS diagnosis and in young and middle-aged MS patients. In contrast, data are conflicting with regard to the association between MS and coronary artery disease including myocardial infarction. Cross-sectional studies found a lower prevalence of coronary artery disease in MS patients, while the only cohort study found an increased risk within the first year after MS diagnosis only. MS was, however, associated with an increased risk of venous thromboembolism, including deep venous thromboembolism and pulmonary embolism, in particular within the first years after MS diagnosis. Discussion: MS is associated with an increased risk of vascular diseases within the first years after a first-time MS diagnosis compared with the general population. The risk declines thereafter, but remains elevated for stroke and venous thromboembolism. Shared risk factors, linked pathogenesis, and bias may contribute to the association.