Risk for Acute Myocardial Infarction Increased in Multiple Sclerosis

heart EKG
heart EKG
Evidence suggests a possible role for inflammation in the association between MS and myocardial infarction risk.

The following article is part of conference coverage from the 34th Congress of the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS) in Berlin, Germany. Neurology Advisor’s staff will be reporting breaking news associated with research conducted by leading experts in neurology. Check back for the latest news from ECTRIMS 2018.

Individuals with multiple sclerosis are at increased risk for acute myocardial infarction, an association that has not been fully explained by normal vascular risk factors. This research was presented at the 34th Congress of the European Committee for Treatment and Research in Multiple Sclerosis held October 10-12, 2018, in Berlin, Germany.

Researchers collected data for this study from health claims in Manitoba and British Columbia, Canada filed between 1984 and 2016. They identified incident cases of multiple sclerosis in either province using a validated case definition. The study researchers matched each case with up to 5 controls of the same sex, age, and region. Incidence rate ratios were used to compare acute myocardial infarction incidence between cases and controls, while the risk for incident acute myocardial infarction was compared using Cox proportional hazards regression. Meta-analysis was utilized to pool findings over different regions while the E-value provided insight into unmeasured confounders.

This retrospective, matched cohort study included 14,565 individuals diagnosed with multiple sclerosis as well as 72,825 matched controls. Among those with multiple sclerosis, 146.2 per 100,000 (95% CI, 129.0-163.5) had incident acute myocardial infarction, while the rate among controls was 128.8 per 100,000 (95% CI, 121.8-135.8). Age standardization resulted in an incidence rate ratio of 1.18 (95% CI, 1.03-1.36) for acute myocardial infarction among those with multiple sclerosis. Adjusting for sex, diabetes, hypertension, socioeconomic status, and hyperlipidemia resulted in a hazard ratio of 1.62 (95% CI, 1.39-1.90). The source of this hazard ratio was unclear. A suspected confounder was considered but was disregarded due to an improbably high risk ratio with both multiple sclerosis and acute myocardial infarction.

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The study researchers concluded that the association may reflect a role of inflammation in the elevated risk seen in this population.

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Marrie RA, Garland A, Kingwell E, et al. Multiple sclerosis is associated with an increased risk of acute myocardial infarction. Presented at: 34th Congress of the European Committee for Treatment and Research in Multiple Sclerosis. October 10-12, 2018; Berlin, Germany. Poster P408.