Hypertension and heart disease are associated with development of brain atrophy in multiple sclerosis: a 5-year longitudinal study

Eur J Neurol. 2019 Jan;26(1):87-e8. doi: 10.1111/ene.13769. Epub 2018 Sep 3.


Background: Cardiovascular diseases (CVDs) are more frequent in multiple sclerosis (MS) patients when compared to controls. In particular, CVDs are linked with higher accumulation of lesions and advanced brain atrophy.

Objective: To investigate whether CVDs contribute to accelerated lesion accumulation and brain atrophy over 5 years in patients with MS.

Methods: 194 MS patients and 43 controls without neurologic disease were followed for 5 years. Full physical, neurological evaluation, and structured questionnaire investigating CVD and risk factors (hypertension, hyperlipidemia, heart disease, smoking, diabetes, obesity/overweight) were collected using interview-based questionnaire and further cross-reference with electronic medical records. Lesion and brain atrophy outcomes were assessed with 3T MRI. ANCOVA adjusted for age, gender, and disease duration were used accordingly. False discovery rate correction was performed using Benjamini-Hochberg correction.

Results: Patients with diagnosis of heart disease showed higher white matter and whole brain volume loss compared to those without (-4.2% vs. -0.7%, P = 0.01 and -3.4% vs. -1.6%, P = 0.01, respectively). The percentage lateral ventricle volume change in MS patients with hypertension was higher compared to non-hypertensive patients (24.5% vs. 14.1%, P = 0.05). Hyperlipidemia, smoking, and obesity/overweight were not associated with progression of MRI-derived outcomes. CVDs did not contribute to larger lesion volume accrual over the 5-year period. The presence of CVDs was not associated with MRI-derived changes in the controls.

Conclusions: Hypertension and heart disease contribute to advanced brain atrophy in MS patients. CVDs did not contribute to additional lesion accrual. CVD comorbidities in MS patients may contribute to neurodegenerative tissue injury that can be detected with brain MRI.

Keywords: MRI; brain atrophy; heart disease; hypertension; lateral ventricular volume; multiple sclerosis.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Atrophy
  • Brain / diagnostic imaging
  • Brain / pathology*
  • Disease Progression
  • Electronic Health Records
  • Female
  • Heart Diseases / diagnostic imaging
  • Heart Diseases / etiology*
  • Humans
  • Hypertension / diagnostic imaging
  • Hypertension / etiology*
  • Lateral Ventricles / diagnostic imaging
  • Longitudinal Studies
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Multiple Sclerosis / complications*
  • Multiple Sclerosis / diagnostic imaging
  • Multiple Sclerosis / pathology
  • Neurologic Examination
  • Risk Factors
  • Surveys and Questionnaires