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

ABSTRACT

Introduction: 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:

• Multiple sclerosis
• MRI
• arterial
• venous
• perfusion
• cardiovascular
• cerebrovascular

Article highlights

• The MS population has higher incidence of cardiovascular diseases when compared to age-matched HCs.

• The presence of cardiovascular diseases (hypertension, hyperlipidemia, heart disease and diabetes) influence low-, mid- and long-term clinical and MRI-derived disease outcomes in MS patients.

• The processes of lesion development, neurodegeneration, and cognitive impairment have been associated with global and local cerebral perfusion changes in MS patients.

• Recent findings propose higher extracranial atherosclerotic risk in MS patients when compared to age-matched HCs.

• Multiple randomized control trials (RCT) have shown no long-term beneficial effect of venous balloon angioplasty in MS patients.

• Future efforts in uncoupling the cardiovascular effect on the biological MS processes are needed and may further influence the clinical and therapeutic decision-making.

Declaration of interest

R Zivadinov received personal compensation from EMD Serono, Genzyme-Sanofi, Celgene and Novartis for speaking and consultant fees. He received financial support for research activities from Genzyme-Sanofi, Novartis, Celgene, Mapi Pharma and Protembis. B Weinstock-Guttman received honoraria as a speaker and as a consultant for Biogen Idec, EMD Serono, Novartis and Mallinckrodt. She also received research funds from Biogen Idec, Teva Pharmaceuticals, EMD Serono, Genzyme-Sanofi and Novartis. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or conflict with the subject matter or materials discussed in this manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

Research reported in this publication was supported by the National Center for Advancing Translational Sciences of the National Institutes of Health under award Number UL1TR001412. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.