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MS research update - Can looking after your heart also help your MS? - 3 March 2015

Summary

Cardiovascular disease is a general term that describes a disease of the heart or blood vessels. There are a number of risk factors that can increase a person's likelihood of developing cardiovascular disease, these include high blood pressure, high cholesterol, smoking and being overweight. Previous research has shown that these risk factors can also have effect on MS symptoms. This study looked at if they could also have effect on the brain in people with MS.

489 people with MS, 61 people with clinically isolated syndrome (CIS) and 175 control participants took part in the study. All participants were clinically assessed by a doctor, had MRI brain scans and completed questionnaires and were interviewed to assess cardiovascular disease risk factors.

When the researchers looked at brain scans they found that people with MS who had one of more of the cardiovascular risk factors such as high blood pressure, smoking or heart disease had brain volume loss (also known as brain atrophy), which is partly due to loss of nerve cells. People with MS who were overweight/obese also had more lesions on their brain scans.

The study found that certain risk factors and behaviours that increase the likelihood of cardiovascular problems also affect the brain in people with MS. The authors conclude that reducing or managing such risk factors in people with MS would benefit their hearts but may also be beneficial to their MS, but further studies would be needed to investigate this.

Background

Cardiovascular disease is a general term that describes a disease of the heart or blood vessels and includes conditions such as stroke and angina. There are a number of risk factors that can increase a person's likelihood of developing cardiovascular disease, these include high blood pressure, high cholesterol, smoking and being overweight. Previous research has shown that these risk factors can also have effect on MS symptoms. This study looked at if they could also have effect on the brain in people with MS.

How this study was carried out

This study is part of a larger project involving over 1,000 people looking at risk factors in MS. This study included a total of 489 people with MS: 326 with relapsing remitting MS, 127 with secondary progressive MS and 36 with primary progressive MS. 61 people with clinically isolated syndrome (CIS) and 175 control participants were also studied.

All participants were clinically assessed by a doctor, had MRI brain scans and completed questionnaires and were interviewed to assess cardiovascular disease risk factors, this information was cross-checked with their medical records.

The cardiovascular disease risk factors looked at were: high blood pressure (hypertension), heart disease, smoking, being overweight/obese and type 1 diabetes.

What was found

People with MS were more likely to be smokers and have high blood pressure than the control participants. They were also more likely to have two or more cardiovascular risk factors than the controls, for example the person being a smoker and having high blood pressure.

When the researchers looked at brain scans they found that people with MS who had one of more of the cardiovascular risk factors such as high blood pressure, smoking or heart disease had brain volume loss (also known as brain atrophy), which is partly due to loss of nerve cells. People with MS who were overweight/obese also had more lesions on their brain scans.

The brain scans from control participants who had been matched to the MS participants for age and gender did not show the same brain loss or lesions.

What does it mean?

The study found that certain risk factors and behaviours that increase the likelihood of cardiovascular problems also affect the brain in people with MS. However the design of this study means, although it can show relationships it cannot prove that the cardiovascular risk factors have caused the brain effect on people with MS. Although the study did find that aged matched controls did not have the same changes in their brains and previous research has shown that these cardiovascular risk factors can cause inflammation and can lead to damage to the brain. The authors also point out that research published last year showed that treating people with simvastatin, which is normally used to lower levels of "bad" cholesterol, helped to reduce brain volume loss in people with SPMS and further research into that is ongoing.

The authors conclude that reducing or managing such risk factors in people with MS would benefit their hearts but may also be beneficial to their MS, but further studies would be needed to investigate this.

Kappus N, Weinstock-Guttman B, Hagemeier J, et al.
Cardiovascular risk factors are associated with increased lesion burden and brain atrophy in multiple sclerosis..
PMID: 25722366 [PubMed - as supplied by publisher]
abstract

More about living well with MS

When it comes to lifestyle, the advice for people with MS is the same as for everyone else – eat healthily, exercise sensibly, avoid smoking and try not to drink too much alcohol. Following such advice can benefit your MS as well as help protect against other health problems too, such as cardiovascular disease.

There is a wide range of help and information available to help you make healthy choices.

Diet: A balanced diet is essential to provide all the nutrients needed to be as active and healthy as possible. This includes foods from the major food groups of fruit and vegetables, carbohydrates, fat, protein and dairy products. You can read more about diet in the A to Z of MS.

Exercise: There is no right or wrong exercise, it should be something that is enjoyable and fits within someone's capabilities exercise can be something energetic or something more leisurely. 

Smoking: There is increasing evidence linking smoking to risk and symptoms in MS. As smoking is also a risk factor for a range of other conditions such as cancers and cardiovascular disease, giving up, or at least cutting down, is recommended. There are a range of support programmes so you could visit your GP to discuss what could work for you. NHS Choices has more information on giving up smoking including eight suggestions of things that could help you stop.

Research by topic areas...

Assessment tools

Davis A, Williams RN, Gupta AS, et al.
Evaluating neurocognitive deficits in patients with multiple sclerosis via a brief neuropsychological approach.
Appl Neuropsychol Adult. 2015 Mar 2:1-7. [Epub ahead of print]
abstract

Michel P, Auquier P, Baumstarck K, et al.
Development of a cross-cultural item bank for measuring quality of life related to mental health in multiple sclerosis patients.
Qual Life Res. 2015 Feb 25. [Epub ahead of print]
abstract

Bone health

Dong G, Zhang N, Wu Z, et al.
Multiple sclerosis increases fracture risk: a meta-analysis.
Biomed Res Int. 2015;2015:650138. Epub 2015 Feb 1. Review.
abstract
Read the full text of this paper

Causes of MS

Pestehchian N, Etemadifarr M, Yousefi HA, et al.
Frequency of blood-tissue parasitic infections in patients with multiple sclerosis, as compared to their family members.
Int J Prev Med. 2014 Dec;5(12):1578-81.
abstract
Read the full text of this paper

CCSVI

Tsivgoulis G, Faissner S, Voumvourakis K, et al.
"Liberation treatment" for chronic cerebrospinal venous insufficiency in multiple sclerosis: the truth will set you free.
Brain Behav. 2015 Jan;5(1):3-12. Epub 2014 Nov 21. Review.
abstract
Read the full text of this paper

Disease modifying treatments

McQueen RB, Livingston T, Vollmer T, et al.
Increased relapse activity for multiple sclerosis natalizumab users who become nonpersistent: a retrospective study.
J Manag Care Spec Pharm. 2015 Mar;21(3):210-8.
abstract

Physical activity

Pearson M, Dieberg G, Smart N.
Exercise as a therapy for improvement of walking ability in adults with multiple sclerosis: a meta-analysis.
Arch Phys Med Rehabil. 2015 Feb 21. [Epub ahead of print]
abstract

Prognosis

Tedeholm H, Skoog B, Lisovskaja V, et al.
The outcome spectrum of multiple sclerosis: disability, mortality, and a cluster of predictors from onset.
J Neurol. 2015 Feb 26. [Epub ahead of print]
abstract

Provision of care

Solomon AJ, Klein EP, Corboy JR, et al.
Patient perspectives on physician conflict of interest in industry-sponsored clinical trials for multiple sclerosis therapeutics.
Mult Scler. 2015 Feb 25. [Epub ahead of print]
abstract

Psychological aspects

Müller R, Gertz KJ, Molton IR, et al.
Effects of a tailored positive psychology intervention on well-being and pain in individuals with chronic pain and a physical disability: a feasibility trial.
Clin J Pain. 2015 Feb 25. [Epub ahead of print]
abstract

Quality of life

Rosato R, Testa S, Oggero A, et al.
Quality of life and patient preferences: identification of subgroups of multiple sclerosis patients.
Qual Life Res. 2015 Feb 26. [Epub ahead of print]
abstract

Sarraf P, Azizi S, Moghaddasi AN, et al.
Relationship between sleep quality and quality of life in patients with multiple sclerosis.
Int J Prev Med. 2014 Dec;5(12):1582-6.
abstract
Read the full text of this paper

Rehabilitation

Schwartz I, Meiner Z.
Robotic-assisted gait training in neurological patients: who may benefit?
Ann Biomed Eng. 2015 Feb 28. [Epub ahead of print]
abstract

Gich J, Freixanet J, García R, et al.
A randomized, controlled, single-blind, 6-month pilot study to evaluate the efficacy of MS-line!: a cognitive rehabilitation programme for patients with multiple sclerosis.
Mult Scler. 2015 Feb 25. [Epub ahead of print]
abstract

Symptoms and symptom management

Strober LB.
Fatigue in multiple sclerosis: a look at the role of poor sleep.
Front Neurol. 2015;6:21.
abstract

Malekzadeh A, Van de Geer-Peeters W, De Groot V, et al.
Fatigue in patients with multiple sclerosis: is it related to pro- and anti-inflammatory cytokines?
Dis Markers. 2015;2015:758314.
abstract
Read the full text of this paper

Work

Honan CA, Brown RF, Batchelor J.
Perceived cognitive difficulties and cognitive test performance as predictors of employment outcomes in people with multiple sclerosis.
J Int Neuropsychol Soc. 2015 Mar 2:1-13. [Epub ahead of print]
abstract

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