Vascular aspects of multiple sclerosis: emphasis on perfusion and cardiovascular comorbidities

Expert Rev Neurother. 2019 May;19(5):445-458. doi: 10.1080/14737175.2019.1610394. Epub 2019 May 10.


Multiple sclerosis (MS) is a chronic inflammatory, demyelinating, and neurodegenerative disease of the central nervous system. Over the last two decades, more favorable MS long-term outcomes have contributed toward increase in prevalence of the aged MS population. Emergence of age-associated pathology, such as cardiovascular diseases, may interact with the MS pathophysiology and further contribute to disease progression. Areas covered: This review summarizes the cardiovascular involvement in MS pathology, its disease activity, and progression. The cardiovascular health, the presence of various cardiovascular diseases, and their effect on MS cognitive performance are further explored. In similar fashion, the emerging evidence of a higher incidence of extracranial arterial pathology and its association with brain MS pathology are discussed. Finally, the authors outline the methodologies behind specific perfusion magnetic resonance imaging (MRI) and ultrasound Doppler techniques, which allow measurement of disease-specific and age-specific vascular changes in the aging population and MS patients. Expert opinion: Cardiovascular pathology significantly contributes to worse clinical and MRI-derived disease outcomes in MS. Global and regional cerebral hypoperfusion may be associated with poorer physical and cognitive performance. Prevention, improved detection, and treatment of the cardiovascular-based pathology may improve the overall long-term health of MS patients.

Keywords: MRI; Multiple sclerosis; arterial; cardiovascular; cerebrovascular; perfusion; venous.

Publication types

  • Research Support, N.I.H., Extramural
  • Review

MeSH terms

  • Cardiovascular Diseases* / diagnostic imaging
  • Cardiovascular Diseases* / epidemiology
  • Cardiovascular Diseases* / physiopathology
  • Cardiovascular Diseases* / therapy
  • Comorbidity*
  • Humans
  • Multiple Sclerosis* / diagnostic imaging
  • Multiple Sclerosis* / epidemiology
  • Multiple Sclerosis* / physiopathology
  • Multiple Sclerosis* / therapy