Cardiovascular disease in patients with multiple sclerosis: a nationwide cohort study in Sweden
ECTRIMS Online Library. Piehl F. 09/12/19; 279447; 148
Fredrik Piehl
Fredrik Piehl
Contributions
Abstract

Abstract: 148

Type: Free Communications

Abstract Category: Clinical aspects of MS - Epidemiology

F. Piehl1, A. Castelo-Branco2, F. Chiesa2, S. Conte2, M. Rosenlund2, S. Lee3, N. Minton3, S. Niemcryk3, A. Lindholm3, S. Montgomery4,5,6

1Department of Neurology, Karolinska University Hospital, 2Real-World Insights, IQVIA Nordics, Solna, Sweden, 3Celgene Corporation, Summit, NJ, United States, 4Clinical Epidemiology and Biostatistics, Örebro University Hospital and Örebro University, Örebro, 5Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden, 6Department of Epidemiology and Public Health, University College London, London, United Kingdom

Introduction: The cardiovascular disease (CVD) rate among multiple sclerosis (MS) patients has been shown to be elevated; however, studies involving more recently diagnosed patients are rare. Here we estimated the rate of CVD in patients before and after MS diagnosis as compared with a matched MS-free population.
Methods: Incident MS patients diagnosed in 2008-2016 were identified in the Swedish National Patient Register. MS patients were matched with 10 MS-free individuals by age, sex, and region of residence. Incidence rates (IR) per 10,000 person-years (PY) and incidence rate ratios (IRR) of cardiovascular outcomes were calculated after MS diagnosis (equivalent date for those without MS) and among those with no history of CVD before this date.
Results: In total, 6,602 MS patients and 61,828 without MS (female, 69%; median age, 40 years) were identified. Before MS diagnosis, patients showed higher proportions of stroke (2.0% vs 0.6%), transient ischaemic attack (TIA) (0.4% vs 0.2%) and peripheral vascular disease (0.3% vs 0.2%) compared with the MS-free cohort. The year before MS diagnosis, larger proportions were prescribed diuretics (8.4% vs 6.9%), peripheral vasodilators (1.4% vs 1.0%), lipid-modifying agents (5.6% vs 4.8%), and calcium channel blockers (3.7% vs 3.1%).
After MS diagnosis, patients had a higher risk of major adverse cardiovascular events (MACE) (IRR 1.35; 95% confidence interval [CI] 1.06-1.71), heart failure (HF) (IRR 1.36; 95% CI 1.02-1.80), and TIA (IRR 1.59; 95% CI 1.05-2.42) compared with the MS-free cohort. The risk of bradycardia (IRR, 2.61; 95% CI 1.14-5.97) was higher only in MS patients with no history of CVD. CVD incidence rates in MS patients were comparable between sexes except for the HF rate, which was higher among males (28.28 per 10,000 PY, 95% CI 18.79-40.87) than females (11.81 per 10,000 PY, 95% CI 7.71-17.30). The relative risk of MACE (IRR 2.40; 95% CI 1.15-5.00), TIA (IRR 7.03; 95% CI 2.62 -18.87), HF (IRR 3.28; 95% CI 1.46-7.37), and bradycardia (IRR 4.51; 95% CI 1.54-13.20) were higher among younger MS patients (aged < 40 years at diagnosis).
Conclusions: After MS diagnosis, MS patients showed an increased incidence of MACE, TIA, and HF compared with those without MS, irrespective of CVD history. The age-matched relative risk was particularly high among younger MS patients. In particular, the relative risk of bradycardia was only higher among younger patients and patients with no history of CVD.
Disclosure:
FP reports research grants from Biogen, Genzyme, Merck KGaA, and Novartis, and fees for serving as Chair of DMC in clinical trials with Parexel. ACB reports that she was paid as a consultant to Celgene Corporation through her employment at IQVIA. FC has nothing to disclose. SC has nothing to disclose. MR reports employment at IQVIA during study conduct, a CRO that received funding from Celgene Corporation for this work. SL is an employee of Celgene Corporation. NM is an employee of Celgene Corporation. SN is an employee of Celgene Corporation. AL is an employee of Celgene Corporation. SM reports research funding from Roche, Novartis, and AstraZeneca; a speaker's fee from Teva; and member of an advisory board for IQVIA.

This study was funded by Celgene Corporation.

Abstract: 148

Type: Free Communications

Abstract Category: Clinical aspects of MS - Epidemiology

F. Piehl1, A. Castelo-Branco2, F. Chiesa2, S. Conte2, M. Rosenlund2, S. Lee3, N. Minton3, S. Niemcryk3, A. Lindholm3, S. Montgomery4,5,6

1Department of Neurology, Karolinska University Hospital, 2Real-World Insights, IQVIA Nordics, Solna, Sweden, 3Celgene Corporation, Summit, NJ, United States, 4Clinical Epidemiology and Biostatistics, Örebro University Hospital and Örebro University, Örebro, 5Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden, 6Department of Epidemiology and Public Health, University College London, London, United Kingdom

Introduction: The cardiovascular disease (CVD) rate among multiple sclerosis (MS) patients has been shown to be elevated; however, studies involving more recently diagnosed patients are rare. Here we estimated the rate of CVD in patients before and after MS diagnosis as compared with a matched MS-free population.
Methods: Incident MS patients diagnosed in 2008-2016 were identified in the Swedish National Patient Register. MS patients were matched with 10 MS-free individuals by age, sex, and region of residence. Incidence rates (IR) per 10,000 person-years (PY) and incidence rate ratios (IRR) of cardiovascular outcomes were calculated after MS diagnosis (equivalent date for those without MS) and among those with no history of CVD before this date.
Results: In total, 6,602 MS patients and 61,828 without MS (female, 69%; median age, 40 years) were identified. Before MS diagnosis, patients showed higher proportions of stroke (2.0% vs 0.6%), transient ischaemic attack (TIA) (0.4% vs 0.2%) and peripheral vascular disease (0.3% vs 0.2%) compared with the MS-free cohort. The year before MS diagnosis, larger proportions were prescribed diuretics (8.4% vs 6.9%), peripheral vasodilators (1.4% vs 1.0%), lipid-modifying agents (5.6% vs 4.8%), and calcium channel blockers (3.7% vs 3.1%).
After MS diagnosis, patients had a higher risk of major adverse cardiovascular events (MACE) (IRR 1.35; 95% confidence interval [CI] 1.06-1.71), heart failure (HF) (IRR 1.36; 95% CI 1.02-1.80), and TIA (IRR 1.59; 95% CI 1.05-2.42) compared with the MS-free cohort. The risk of bradycardia (IRR, 2.61; 95% CI 1.14-5.97) was higher only in MS patients with no history of CVD. CVD incidence rates in MS patients were comparable between sexes except for the HF rate, which was higher among males (28.28 per 10,000 PY, 95% CI 18.79-40.87) than females (11.81 per 10,000 PY, 95% CI 7.71-17.30). The relative risk of MACE (IRR 2.40; 95% CI 1.15-5.00), TIA (IRR 7.03; 95% CI 2.62 -18.87), HF (IRR 3.28; 95% CI 1.46-7.37), and bradycardia (IRR 4.51; 95% CI 1.54-13.20) were higher among younger MS patients (aged < 40 years at diagnosis).
Conclusions: After MS diagnosis, MS patients showed an increased incidence of MACE, TIA, and HF compared with those without MS, irrespective of CVD history. The age-matched relative risk was particularly high among younger MS patients. In particular, the relative risk of bradycardia was only higher among younger patients and patients with no history of CVD.
Disclosure:
FP reports research grants from Biogen, Genzyme, Merck KGaA, and Novartis, and fees for serving as Chair of DMC in clinical trials with Parexel. ACB reports that she was paid as a consultant to Celgene Corporation through her employment at IQVIA. FC has nothing to disclose. SC has nothing to disclose. MR reports employment at IQVIA during study conduct, a CRO that received funding from Celgene Corporation for this work. SL is an employee of Celgene Corporation. NM is an employee of Celgene Corporation. SN is an employee of Celgene Corporation. AL is an employee of Celgene Corporation. SM reports research funding from Roche, Novartis, and AstraZeneca; a speaker's fee from Teva; and member of an advisory board for IQVIA.

This study was funded by Celgene Corporation.

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