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Original research
Risk of stroke in multiple sclerosis and neuromyelitis optic spectrum disorder: a Nationwide cohort study in South Korea
  1. Eun Bin Cho1,2,
  2. Yohwan Yeo3,
  3. Jin Hyung Jung4,
  4. Su-Min Jeong5,
  5. Kyung-do Han6,
  6. Dong Wook Shin5,7,8,
  7. Ju-Hong Min9,10,11
  1. 1Department of Neurology, College of Medicine, Gyeongsang Institute of Health Science, Gyeongsang National University, Jinju, South Korea
  2. 2Department of Neurology, Gyeongsang National University Changwon Hospital, Changwon, South Korea
  3. 3Department of Family Medicine, College of Medicine, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, South Korea
  4. 4Department of Biostatistics, College of Medicine, The Catholic University of Korea, Seoul, South Korea
  5. 5Department of Family Medicine & Supportive Care Center, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, South Korea
  6. 6Department of Statistics and Actuarial Science, Soongsil University, Seoul, South Korea
  7. 7Department of Clinical Research Design & Evaluation and Digital Health, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University, Seoul, South Korea
  8. 8Center for Wireless and Population Health Systems, University of California San Diego, San Diego, CA, USA
  9. 9Department of Neurology, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, South Korea
  10. 10Department of Neurology, Neuroscience Center, Samsung Medical Center, Seoul, South Korea
  11. 11Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University, Seoul, South Korea
  1. Correspondence to Dr Ju-Hong Min, Department of Neurology, Samsung Medical Center Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea; juhongm{at}skku.edu; Dr Dong Wook Shin, Department of Family Medicine & Supportive Care Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 06351, Republic of Korea; dwshin.md{at}gmail.com

Abstract

Background People with multiple sclerosis (MS) are more likely to develop stroke than those without. However, little is known about the association between neuromyelitis optica spectrum disorder (NMOSD) and the risk of stroke. We aimed to estimate the risk of stroke in patients with MS and NMOSD in South Korea.

Methods Data from the Korean National Health Insurance between January 2010 and December 2017 were analysed. A total of 1541/1687 adult patients with MS/NMOSD, who were free of stroke were included. Matched controls were selected based on age, sex and the presence of hypertension, diabetes mellitus and dyslipidaemia.

Results The risk of developing stroke was 2.78 times higher (adjusted HR (aHR), 95% CI 1.91 to 4.05) in patients with MS compared with controls matched by age, sex, hypertension, diabetes mellitus and dyslipidaemia. The risk of stroke in NMOSD was also higher than that in matched controls (aHR=1.69, 95% CI 1.10 to 2.61) and not statistically different from that of MS (p=0.216). The patients with MS had a higher risk for either of ischaemic or haemorrhagic stroke (HR=2.63 and 2.93, respectively), whereas those with NMOSD had a higher risk for ischaemic stroke (HR=1.60) with marginal statistical significance.

Conclusions The risk of stroke is increased in patients with MS and NMOSD and seemed comparable between the two conditions. This is the first study that estimates the risk of stroke in patients with MS and NMOSD within the same population.

  • MULTIPLE SCLEROSIS
  • STROKE
  • NEUROEPIDEMIOLOGY

Data availability statement

Data are available upon reasonable request.

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Data availability statement

Data are available upon reasonable request.

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Footnotes

  • EBC and YY contributed equally.

  • Contributors EBC, YY, DWS, J-HM: study conception and design, data analysis and interpretation, manuscript drafting and revision. JHJ, K-dH: data analysis and interpretation. S-MJ: data interpretation, critical review of manuscript. DWS and J-HM act as guarantors, accept full responsibility for the work and/or the conduct of the study, had access to the data, and controlled the decision to publish.

  • Funding This research was partially supported by a grant of the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, Republic of Korea (grant number: HI20C1073). The funding source was not involved in the study design, data collection, data analysis or data interpretation of this study.

  • Competing interests J-HM has lectured, consulted and received Honoria from Bayer Schering Pharma, Merck Serono, Biogen Idec, Sanofi Genzyme, Teva-Handok, UCB, Samsung Bioepis, Mitsubishi Tanabe Pharma and Roche and has received a grant from the National Research Foundation of Korea and SMC Research and Development Grant. The other authors report no competing interests.

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

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.