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Distinct influence of different vascular risk factors on white matter brain lesions in multiple sclerosis
  1. Ruth Geraldes1,2,
  2. Maciej Juryńczyk1,
  3. Giordani dos Passos1,
  4. Alexander Prichler3,
  5. Karen Chung4,
  6. Marloes Hagens5,
  7. Serena Ruggieri6,
  8. Elena Huerga7,
  9. Jaume Sastre-Garriga8,
  10. Christian Enzinger3,
  11. Declan T Chard4,9,
  12. Frederik Barkhof10,11,
  13. Claudio Gasperini6,
  14. Alex Rovira12,
  15. Gabriele C DeLuca1,
  16. Jacqueline Palace13
  17. on behalf of the MAGNIMS study group
  1. 1 Nuffield Department of Clinical Neurosciences, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
  2. 2 Neurology, Frimley Health NHS Foundation Trust, Frimley, UK
  3. 3 Department of Neurology, Medical University of Graz, Graz, Österreich, Austria
  4. 4 NMR Research Unit, Queen Square Multiple Sclerosis Centre, University College London, London, UK
  5. 5 Department of Neurology, MS Center, Vrije Universiteit Amsterdam, Amsterdam, Noord-Holland, The Netherlands
  6. 6 Centro Sclerosi Multipla, Osp. San Camillo Forlanini, Roma, Italy
  7. 7 Magnetic Resonance Unit. Department of Radiology (IDI), Hospital Vall d\'Hebron, Barcelona, Catalunya, Spain
  8. 8 Multiple Sclerosis Center of Catalonia, Hospital Universitari Vall d'Hebron, Barcelona, Spain
  9. 9 National Institute for Health Research (NIHR), University College London Hospitals (UCLH) Biomedical Research Centre, London, UK
  10. 10 Department of Radiology, VU Medical Center, MS Center, Amsterdam, Netherlands
  11. 11 Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, Faculty of Brain Sciences, University College London, UK; and National Institute for Health Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Centre, London, UK
  12. 12 Unitat de Ressonància Magnètica (IDI), Servei de Radiologia, Vall d'Hebron University Hospital, Barcelona, Spain
  13. 13 Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK
  1. Correspondence to Dr Jacqueline Palace, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford OX3 9DU, UK; jacqueline.palace{at}ndcn.ox.ac.uk

Abstract

Objective To determine if vascular risk factor (VRF), that is, smoking, arterial hypertension (HT), dyslipidaemia and diabetes, have an effect on multiple sclerosis (MS) pathology as measured by MS typical brain lesions, we have compared brain MRIs from patients with MS with and without VRF age-matched and sex-matched.

Methods Brain MRIs from five centres were scored for the presence of Dawson’s fingers (DF) and juxtacortical lesions (JCL). A regression model was built to predict the effect of each individual VRF on DF and JCL, considering age and disease duration.

Results 92 MS cases without VRF and 106 MS with one or more VRF (80 ever-smokers, 43 hypertensives, 25 dyslipidaemics and 10 diabetics) were included. Ever-smoking associated with a higher burden of DF (Exp(B)=1.29, 95% CI 1.10 to 1.51, p<0.01) and JCL (Exp(B)=1.38, 95% CI 1.21 to 1.57, p<0.01). No other VRF had an impact on DF. Dyslipidaemia associated with increased JCL (Exp(B)=1.30, 95% CI 1.10 to 1.56, p<0.01) but HT did not associate with any of the outcomes.

Conclusions Individual VRF appear to affect MS-specific lesions differently. An increase in MS lesions was mainly seen in smokers; however, this VRF is most likely to be present from onset of MS, and other VRF effects may be partly mitigated by treatment. Our findings support that treating VRF and cessation of smoking may be important in the management of MS.

  • multiple sclerosis
  • MRI
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Footnotes

  • Contributors RG and JP: designed and conceptualised study, analysed the data and drafted the manuscript for the intellectual content. MJ, GdP, AP, KC, JS-G, CE, DTC, FB and AR: major role in the acquisition of data and revised the manuscript for intellectual content. MH, SR and EH: major role in the acquisition of data. GCD: interpreted the data and revised the manuscript for intellectual content.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests RG has received support for scientific meetings and courses or honoraria for advisory work from Wolfson College, by the EAN, Bayer, Biogen, Merck and Novartis. GdP has received scholarships from the ECTRIMS, the World Federation of Neurology and Novartis; funding for research from Biogen, Novartis and Roche; travel grants from Roche, Sanofi-Genzyme and Teva and fees for editorial content from Bayer, Merck Serono and Roche. KC has received honoraria for speaking at meetings, advisory work or support to attend meetings from Teva, Biogen Idec and Roche. JS-G reports in the last 36 months grants and personal fees from Genzyme, personal fees from: Biogen, Bayer, Merck, Almirall, Bial, Novartis, Roche, TEVA, Celgene; he is Director of Revista de Neurologia, for which he does not receive any compensation, and serves of Editorial Board of Multiple Sclerosis Journal, for which he receives a compensation. CE has received funding for travel and speaker honoraria from Biogen, Bayer, Genzyme, Merck, Novartis, Shire and Teva, research support from Biogen, Merck and Teva, and has served on scientific advisory boards for Bayer, Biogen, Merck, Novartis, Roche and Teva. DTC has received, in the last 3 years, honoraria (paid to his employer) from Excemed for faculty-led education work; had meeting expenses funded by EAN, ECTRIMS, Novartis and Société des Neurosciences. He has received research funding from the International Progressive MS Alliance, the MS society of Great Britain and Northern Ireland and the Institute for Health Research (NIHR), University College London Hospitals (UCLH) Biomedical Research Centre. GCD is supported by the NIHR Biomedical Research Centre (BRC), Oxford and has research funding from the Oxford BRC, MRC (UK) and Merck-Serono. He has received travel expenses from Bayer Schering, Biogen Idec, Genzyme, Merck Serono and Novartis and honoraria as an invited speaker for Bayer Schering and Novartis. JP is partly funded by highly specialised services to run a national congenital myasthenia service and a neuromyelitis service. She has received support for scientific meetings and honorariums for advisory work from Merck Serono, Biogen Idec, Novartis, Teva, Chugai Pharma and Bayer Schering, Alexion, Roche, Genzyme, MedImmune, EuroImmune, MedDay, Abide and ARGENX, and grants from Merck Serono, Novartis, Biogen Idec, Teva, Abide and Bayer Schering. She has received grants from the MS society and Guthie Jackson Foundation for research studies. FB serves as a consultant for Biogen, Bayer, Genzyme, Jansen Research, Merck, Novartis, Roche, Synthon BV and Teva. CG has received compensation for consulting from Bayer and Biogen and speaker's fees for lectures from Biogen, Bayer, Genzyme, Merck, Novartis and Teva. AR serves on scientific advisory boards for Novartis, Sanofi-Genzyme, Icometrix, SyntheticMR, Bayer, Biogen and OLEA Medical and has received speaker honoraria from Bayer, Sanofi-Genzyme, Bracco, Merck-Serono, Teva Pharmaceutical Industries Ltd, Novartis, Roche and Biogen.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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