The presence of cardiovascular (CV) risk factors is associated with brain atrophy in relatively young MS patients under the age of 50. CV risk factors seem to have synergistic effects in MS.

CV risk factors have been associated with changes in clinical and MRI outcomes in MS patients before. For example, vascular risk factors, coronary heart disease, or peripheral arterial disease have all been associated with a substantially increased risk of disability progression. MS patients with migraine, hyperlipidemia, or a high comorbidity burden have shown an increased relapse rate over 2 years. A more favorable lipid profile has been associated with lower Gd-positive lesion volume. However, previous studies have not set an age-limit, while older patients may be affected by cerebral small vessel disease-related damage in addition to MS; nor has the strength of exposure – for example pack-years (PY) for smoking – been graded.

An Italian group aimed to evaluate the impact of CV risk factors on T2 hyperintense lesion volume and on brain atrophy in MS patients under the age of 50 years [1]. Subjects were 124 MS patients (relapsing-remitting MS n=79, progressive MS n=45) plus 95 healthy age- and sex-matched controls. They underwent complete neurological assessment and brain 3D T2-weighted and FLAIR images, and 3D T1-weighted images. Traditional CV risk factors that were assessed included having smoked ≥5 PY, hypertension, dyslipidemia, and diabetes/prediabetes. More stringent cut-offs were also assessed: having smoked ≥10 PY, and hypertension, dyslipidemia, or diabetes while on treatment. Of 124 MS patients, 48 had 1 traditional CV risk factor, 15 had more than 1. Of 95 controls, 19 had 1 risk factor, 4 had more (P<0.001). Thirty and 8 MS patients had 1 or more than 1 stringent risk-factor, respectively; as did 10 and 3 healthy controls (P=0.01). Most had smoking as a CV risk factor.

In MS patients, having 2 or more traditional CV risk factors was associated with reduced normalized grey matter volume (P=0.01), white matter volume (P=0.03), and whole brain volume (P=0.003), but not with T2 lesion volume (P=0.27). Only hypertension was associated with MRI measures (white matter and whole brain volume). Having 1 stringent CV risk factor was associated with reduced grey matter volume (P=0.006), white matter volume (P=0.003), whole brain volume (P<0.001), and higher T2 lesion volume (P=0.03). In matched healthy controls, neither traditional nor stringent risk factors were found to have significant impact on any of the above-mentioned measures.


  1. Bonacchi R, et al. MSVIRTUAL2020, PS04.05