Research: MS and stroke

EpubZöller et al. Risk of subsequent ischemic and haemorrhagic stroke in patients hospitalized for immune-mediated diseases: a nationwide follow-up study from Sweden. BMC Neurol. 2012;12(1):41.

Background: Certain immune immune-mediated diseases (IMD) have been associated with increased risk for cardiovascular disorders. 

Aim: The aim of this study was to examine whether there is an association between 32 different IMD and first hospitalization for ischemic or hemorrhagic stroke. 

Methods: All individuals in Sweden hospitalized with a main diagnosis of IMD (without previous or coexisting stroke), between January 1, 1987 and December 31, 2008 (n=216,291), were followed for first hospitalization for ischemic or hemorrhagic stroke. The reference population was the total population of Sweden. Adjusted standardized incidence ratios (SIRs) for ischemic and hemorrhagic stroke were calculated.

Results: Totally 20 and 15 of the 32 IMD studied, respectively were associated with an increased risk of ischemic or hemorrhagic stroke during follow-up. Overall risk of ischemic and hemorrhagic stroke during the first year after hospitalization for IMD was 2.02 (95% CI 1.90-2.14) and 2.65 (95% CI 2.27-3.08), respectively. The overall risk of ischemic or hemorrhagic stroke decreased over time, from 1.50 (95% CI 1.46-1.55) and 1.83 (95% CI 1.69-1.98), respectively, after 1-5 years, to 1.29 (95% CI 1.23-1.35) and 1.47 (95% CI 1.31-1.65), respectively, after 10+ years. Risk of hemorrhagic stroke was [greater than or equal to] 2 during the first year after hospitalization for seven IMD: ankylosing spondylitis (SIR=8.11), immune thrombocytopenic purpura (SIR=8.60), polymyalgia rheumatica (SIR=2.06), psoriasis (SIR=2.88), rheumatoid arthritis (SIR=3.27), systemic lupus erythematosus (SIR=8.65), and Wegener’s granulomatosis (SIR=5.83). Risk of ischemic stroke was [greater than or equal to] 2 during the first year after hospitalization for twelve IMD: Addison’s disease (SIR=2.71), Crohn’s disease (SIR=2.15), Grave’s disease (SIR=2.15), Hashimoto’s thyroiditis (SIR=2.99), immune thrombocytopenic purpura (SIR=2.35), multiple sclerosis (SIR=3.05), polymyositis/dermatomyositis (SIR=3.46), rheumatic fever (SIR=3.91), rheumatoid arthritis (SIR=2.08), Sjogren’s syndrome (SIR=2.57), systemic lupus erythematosus (SIR=2.21), and ulcerative colitis (SIR=2.15).

Conclusions: Hospitalization for many IMD is associated with increased risk of ischaemic or haemorrhagic stroke. The findings suggest that several hospitalized IMD are linked to cererobrovascular disease.

EpubChristiansen CF. Risk of vascular disease in patients with multiple sclerosis: a review. Neurol Res. 2012 Jun 16.

BACKGROUND: Vascular dysfunction and shared risk factors may lead to an increased risk of arterial and venous vascular disease in MSers. 

AIM: The aim of this review was to describe studies examining the risk of vascular diseases in MSers.

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 MSers. 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 MSers. 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 MSers, 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 firs 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.

“I learn something new about MS everyday of the week; the information about MSers being at increased risk of stroke is new. I wonder why? Could it be due to inflammation increasing the ability of the blood to clot. i.e. being pro-coagulant? This much be telling us something about the pathogenesis of MS. What?”

“It makes sense why MSers are at increased risk of having deep vein thromboses and pulmonary emboli (clots to the lungs); being less mobile puts you at increased risk of this complication.”

4 thoughts on “Research: MS and stroke”

  1. This implies that exercising, in whatever way you can, is impoprtant for MSers. Is that right?

  2. Re: "This implies that exercising, in whatever way you can, is impoprtant for MSers. Is that right?"Partially correct; the aim should be to exercise, but not all MSers are in a position to exercise. Someone with an EDSS of 8.0 or 9.0 can't exercise.

  3. But how many of these people smoked or had a lifestyle conducive to stroke? What incidence of this population had high blood pressure? Did any of these studies factor in other considerations that might lead to a higher risk of suffering a stroke? Liz

  4. My sister has Progrssive MS and recently had a stroke,she has taken good care of herself, never smoked or drank, a healthy eater. Was diagnosed almost 10 years ago. Age is 62, BP and cholesterol were only slightly high.

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