Influence of hypertension,diabetes,hyperlipidemia,and obstructive lung disease on multiple sclerosis disease course

Abstract

Background:

Comorbidities are known to affect multiple sclerosis (MS) patients in a number of ways, including delaying time to diagnosis and reducing health-related quality of life.

Objective:

To determine the impact of hypertension, hyperlipidemia, diabetes mellitus, and obstructive lung disease on disease course in MS patients.

Methods:

The Knowledge Program is a database linked to our electronic medical record allowing capture of patient and clinician reported outcomes. Through Knowledge Program query and chart review, we identified all relapsing-remitting MS patients seen between 1 January 2010 and 29 May 2012 and acquired their magnetic resonance imaging (MRI) results and comorbidities. Linear and logistic regression models with adjustment for important covariates were used to determine whether the comorbidities affected outcomes over a 3-year period.

Results:

Hypertension, diabetes, and obstructive lung disease, but not hyperlipidemia, impacted clinical outcomes, including walking speed, self-reported disability, and depression. Hypertension had the greatest effect. The presence of multiple comorbidities had a cumulative effect on clinical outcomes. MRI outcomes were unaffected by comorbidities.

Conclusion:

This 3-year longitudinal study revealed that all comorbidities tested except hyperlipidemia impacted clinical outcomes and a cumulative effect with multiple comorbidities was observed. Consideration of comorbid conditions is essential in MS patient care.

Keywords

Multiple sclerosis comorbidity outcome measurement database disease course

Get full access to this article

View all access options for this article.

References

Marrie

Horwitz

. Emerging effects of comorbidities on multiple sclerosis. Lancet Neurol 2010; 9(8): 820–828.

Marrie

Horwitz

Cutter

. Comorbidity delays diagnosis and increases disability at diagnosis in MS. Neurology 2009; 72(2): 117–124.

Marrie

Horwitz

Cutter

. Cumulative impact of comorbidity on quality of life in MS. Acta Neurol Scand 2012; 125(3): 180–186.

Marrie

Cohen

Stuve

. A systematic review of the incidence and prevalence of comorbidity in multiple sclerosis: Overview. Mult Scler 2015; 21(3): 263–281.

Marrie

Rudick

Horwitz

. Vascular comorbidity is associated with more rapid disability progression in multiple sclerosis. Neurology 2010; 74(13): 1041–1047.

Marrie

Miller

Sormani

. Recommendations for observational studies of comorbidity in multiple sclerosis. Neurology 2016; 86: 1446–1453.

Katzan

Speck

Dopler

. The knowledge program: An innovative, comprehensive electronic data capture system and warehouse. AMIA Annu Symp Proc 2011; 2011: 683–692.

Schwartz

Vollmer

Lee

. Reliability and validity of two self-report measures of impairment and disability for MS. North American Research Consortium on Multiple Sclerosis Outcomes Study Group. Neurology 1999; 52(1): 63–70.

Marrie

Goldman

. Validity of performance scales for disability assessment in multiple sclerosis. Mult Scler 2007; 13(9): 1176–1182.

10.

Spitzer

Kroenke

Williams

. Validation and utility of a self-report version of PRIME-MD: The PHQ primary care study. Primary Care Evaluation of Mental Disorders. Patient Health Questionnaire. JAMA 1999; 282(18): 1737–1744.

11.

Rudick

Cutter

Reingold

. The multiple sclerosis functional composite: A new clinical outcome measure for multiple sclerosis trials. Mult Scler 2002; 8(5): 359–365.

12.

Hojsgaard

Halekoh

Yan

. The R package geepack for generalized estimating equations. J Stat Softw 2006; 15(2): 1–11.

13.

Yan

Fine

. Estimating equations for association structures. Stat Med 2004; 23(6): 859–874; discussion 875–877, 879–880.

14.

Yan

. Geepack: Yet another package for generalized estimating equations. R-News 2002; 2–3: 12–14.

15.

Rubin

. Multiple imputation for nonresponse in surveys. New York: John Wiley & Sons, 1987.

16.

Van Buuren

Brand

JPL

Groothuis-Oudshoorn

. Fully conditional specification in multivariate imputation. J Stat Comput Simul 2006; 76(12): 1049–1064.

17.

Van Buuren

Groothuis-Oudshoorn

CGM

. Mice: Multivariate imputation by chained equations in R. J Stat Softw 2011; 45(3): 1–67.

18.

Kang

Chen

Lin

. Comorbidities amongst patients with multiple sclerosis: A population-based controlled study. Eur J Neurol 2010; 17(9): 1215–1219.

19.

Marrie

Leung

. Rising prevalence of vascular comorbidities in multiple sclerosis: Validation of administrative definitions for diabetes, hypertension, and hyperlipidemia. Mult Scler 2012; 18(9): 1310–1319.

20.

Roxburgh

Seaman

Masterman

. Multiple sclerosis severity score: Using disability and disease duration to rate disease severity. Neurology 2005; 64(7): 1144–1151.

21.

Moccia

Lanzillo

Palladino

. The Framingham cardiovascular risk score in multiple sclerosis. Eur J Neurol 2015; 22(8): 1176–1183.

22.

Salerno

Murphy

Horwitz

. Brain atrophy in hypertension. A volumetric magnetic resonance imaging study. Hypertension 1992; 20(3): 340–348.

23.

Nagai

Hoshide

Ishikawa

. Ambulatory blood pressure as an independent determinant of brain atrophy and cognitive function in elderly hypertension. J Hypertens 2008; 26(8): 1636–1641.

24.

Marrie

Reider

Cohen

. A systematic review of the incidence and prevalence of cardiac, cerebrovascular, and peripheral vascular disease in multiple sclerosis. Mult Scler 2015; 21(3): 318–331.

25.

Weinstock-Guttman

Zivadinov

Horakova

. Lipid profiles are associated with lesion formation over 24 months in interferon-beta treated patients following the first demyelinating event. J Neurol Neurosurg Psychiatry 2013; 84(11): 1186–1191.

26.

Weinstock-Guttman

Zivadinov

Mahfooz

. Serum lipid profiles are associated with disability and MRI outcomes in multiple sclerosis. J Neuroinflammation 2011; 8: 127.

27.

Tettey

Simpson

Jr Taylor

. An adverse lipid profile is associated with disability and progression in disability, in people with MS. Mult Scler 2014; 20(13): 1737–1744.

28.

Tettey

Simpson

Jr Taylor

. Adverse lipid profile is not associated with relapse risk in MS: Results from an observational cohort study. J Neurol Sci 2014; 340(1–2): 230–232.

29.

Weber

Youssef

Dunn

. Statins in the treatment of central nervous system autoimmune disease. J Neuroimmunol 2006; 178(1–2): 140–148.

30.

Tremlett

Evans

Wiles

. Asthma and multiple sclerosis: An inverse association in a case-control general practice population. QJM 2002; 95(11): 753–756.

31.

Kappus

Weinstock-Guttman

Hagemeier

. Cardiovascular risk factors are associated with increased lesion burden and brain atrophy in multiple sclerosis. J Neurol Neurosurg Psychiatry 2016; 87: 181–187.

32.

Martin

Ul-Haq

Nicholl

. Cardiometabolic disease and features of depression and bipolar disorder: Population-based, cross-sectional study. Br J Psychiatry 2016; 208: 343–351.

33.

Miller

. Teriflunomide: A once-daily oral medication for the treatment of relapsing forms of multiple sclerosis. Clin Ther 2015; 37(10): 2366–2380.

34.

Berkovich

. Treatment of acute relapses in multiple sclerosis. Neurotherapeutics 2013; 10(1): 97–105.