Introduction
Multiple Sclerosis (MS) is a complex neurological disorder that not only affects the central nervous system but has also been associated with an increased risk of cardiovascular issues. Studies have shown a higher prevalence of ischemic heart disease, congestive heart failure, and abnormalities in blood pressure, heart rate, and dyslipidaemia (imbalance in levels of fats in the blood) among individuals with MS compared to the general population. In this blog, I’ll look into the relationship between MS and cardiovascular risk, exploring the various factors that contribute to this association.
Risk factors in people with MS
- Macrovascular Disease (MVD) and atherosclerosis
Individuals with MS face an elevated risk of MVD, affecting large blood vessels like coronary arteries, the aorta, and major arteries in the brain and limbs. Atherosclerosis, characterised by the build-up of plaque on vessel walls, is a key contributor to MVD. Chronic inflammation, which is seen in MS, may damage blood vessel walls, making them more susceptible to plaque formation. Studies have shown that women with MS may be at a greater risk of macrovascular disease and myocardial infarction compared to men (as if we didn’t already have enough to deal with).
- Diabetes and cardiovascular risk
People with MS are more likely to have diabetes at the time of diagnosis than the general population. Diabetes is a known cardiovascular risk factor, and its coexistence with MS may contribute to an increased susceptibility to cardiovascular complications.
- Autonomic cardiovascular dysfunction
Correlations have been observed between autonomic cardiovascular dysfunction (the autonomic nervous system is involved in all the stuff that happens without our conscious control) and secondary progressive MS. Plaques in the spinal cord and brain disrupt autonomic pathways, potentially leading to altered blood pressure and heart rate responses. Lesions in reflex pathways within the brainstem further contribute to cardiovascular irregularities.
- Heart rate variability (HRV)
HRV, an indicator of autonomic nervous system activity, is crucial for adaptability to stress and overall health. Individuals with MS often exhibit decreased HRV, suggesting reduced adaptability to stress, impaired cardiovascular regulation, and potential links to disease progression, fatigue, and pain.
Understanding the mechanisms
The precise mechanisms linking MS and cardiovascular risk are still under investigation. Chronic inflammation, autoimmune responses affecting cholesterol metabolism, lifestyle factors (such as physical inactivity, an unhealthy diet, and smoking), and certain medications used to treat MS, particularly corticosteroids, are considered contributing factors.
- Higher levels of LDL cholesterol (often referred to as “bad cholesterol”), total cholesterol, and triglycerides are associated with worsening disability, with increased total cholesterol linked to more MRI brain lesions in clinically isolated syndrome patients. This may be due to altered mechanisms in the blood-brain barrier vascular endothelium from an increased recruitment of immune cells.
- Chronic inflammation in MS may play a role. Inflammation damages blood vessel walls, making them more susceptible to plaque buildup and atherosclerosis, the underlying cause of MVD. Additionally, inflammatory cells might directly contribute to cholesterol dysregulation.
- The immune system dysfunction underlying MS might directly affect cholesterol metabolism and its regulation. Some studies suggest autoantibodies targeting specific proteins involved in cholesterol transport and processing may be at play.
- Individuals with MS might be more prone to certain lifestyle factors associated with MVD, including physical inactivity, an unhealthy diet, and smoking. These factors can further exacerbate the risk associated with MS itself.
- Some medications used to treat MS, particularly corticosteroids, can raise LDL cholesterol levels as a side effect. This highlights the need for regular monitoring and potential adjustments to manage both MS and cardiovascular risks.
- Vitamin D deficiency, common in people with MS, has been linked to an increased risk of MVD. Additionally, genetic susceptibility might play a role in some individuals.
Conclusion
As individuals with MS face an increased vascular burden compared to the general population, vascular management should be an integral part of their overall care. Regular screening for risk factors, including cholesterol levels, blood pressure, and smoking habits, is essential. Lifestyle modifications, such as maintaining a healthy diet and weight management, play a vital role in reducing cardiovascular risk.
It is important to recognise that not all individuals with MS experience elevated LDL cholesterol or develop cardiovascular diseases, however, understanding and addressing cardiovascular risk factors early on can contribute to better overall health outcomes for those living with MS. Additionally, as some disease-modifying therapies may have side effects, close monitoring and potential adjustments are necessary to manage both MS and cardiovascular risks. Overall, a holistic approach to healthcare, considering both neurological and cardiovascular aspects, and the effect of nutrition, is important for individuals with MS.
If you would like support on your MS health journey, take a look at the range of nutritional therapy programmes which I offer. Please contact me for a free discovery call for more information. I look forward to working with you soon.