MS, vascular disease and vitamin D are somewhat related

#MSBlog: Preventing vascular disease may impact on the course of MS; vD supplements may be one way of doing this!

"At the recent IPMSC (International Progressive Multiple Sclerosis Collaborative) meeting in Milan a lot of discussion was centered around the topic of progressive MS and other co-morbidties; i.e. other diseases that may not be associated with MS, but can contribute to its progression. Several attendees suggested that the reason why Simvastatin, a drug that reduces cholesterol and cardiovascular events, including cardiovascular deaths (heart attacks and stroke), works in MS is that it is treating the co-morbidities that contribute to MS progression. Interesting?"

"The following paper confirms that MSers are as likely to suffer from vascular diseases as the general population, which may explain why age is such an important risk factor for disease progression."

Marrie et al. Rising prevalence of vascular comorbidities in multiple sclerosis: validation of administrative definitions for diabetes, hypertension, and hyperlipidemia. Mult Scler. 2012 Sep;18(9):1310-9.

BACKGROUND: Despite the importance of comorbidity in multiple sclerosis (MS), methods for comorbidity assessment in MS are poorly developed.


OBJECTIVE: They validated and applied administrative case definitions for diabetes, hypertension, and hyperlipidemia in MS.

METHODS: Using provincial administrative data they identified MSers and a matched general population cohort. Case definitions for diabetes, hypertension, and hyperlipidemia were derived using hospital, physician, and prescription claims, and validated in 430 MSers. They examined temporal trends in the age-adjusted prevalence of these conditions from 1984-2006.

RESULTS: Agreement between various case definitions and medical records ranged from kappa (κ) =0.51-0.69 for diabetes, κ =0.21-0.71 for hyperlipidemia, and κ =0.52-0.75 for hypertension. The 2005 age-adjusted prevalence of diabetes was similar in the MS (7.62%) and general populations (8.31%; prevalence ratio [PR] 0.91; 0.81-1.03). The age-adjusted prevalence did not differ for hypertension (MS: 20.8% versus general: 22.5% [PR 0.91; 0.78-1.06]), or hyperlipidemia (MS: 13.8% versus general: 15.2% [PR 0.90; 0.67-1.22]). The prevalence of all conditions rose in both populations over the study period.

CONCLUSION: Administrative data are a valid means of tracking diabetes, hypertension, and hyperlipidemia in MS. The prevalence of these comorbidities is similar in the MS and general populations.

"Why are comorbidities important? If they are contributing to disease progression and MS-related mortality then any holistic approach to MS should address these diseases. Which is why the following non-MS-related   vitamin D studies are so important. They are well performed epidemiology studies from Denmark that show low vitamin D levels increase your chances of heart disease and stroke. The implications are that if you keep your vD levels high you may be able to prevent or delay vascular disease. This is another reason why MSers should keep themselves vD replete; most vD experts consider a level between 100-150nmol/L to be optimal."


Brøndum-Jacobsen et al. 25-hydroxyvitamin d levels and risk of ischemic heart disease, myocardial infarction, and early death: population-based study and meta-analyses of 18 and 17 studies. Arterioscler Thromb Vasc Biol. 2012 Nov;32(11):2794-802.

OBJECTIVE:  They tested the hypothesis that reduced plasma 25-hydroxyvitamin D associates with increased risk of ischemic heart disease, myocardial infarction, and early death.

METHODS AND RESULTS: They measured baseline plasma 25-hydroxyvitamin D in 10 170 women and men from the Danish general population without vitamin D-fortified food. During 29 years of follow-up, 3100 persons developed ischemic heart disease, 1625 myocardial infarction, and 6747 died. Decreasing plasma 25-hydroxyvitamin D levels were associated with increasing risk of ischemic heart disease, myocardial infarction, and early death as a function of seasonally adjusted percentile categories (P for trend, 2×10(-4)-3×10(-53)). Comparing individuals with plasma 25-hydroxyvitamin D levels at the 1st to 4th percentile with individuals with levels at the 50th to 100th percentile, the multivariable adjusted risk was increased by 40% (95% CI, 14%-72%) for ischemic heart disease, by 64% (25%-114%) for myocardial infarction, by 57% (38%-78%) for early death, and by 81% (40%-135%) for fatal ischemic heart disease/myocardial infarction. In the meta-analyses of 18 and 17 studies, risk of ischemic heart disease and early death were increased by 39% (25%-54%) and 46% (31%-64%) for lowest versus highest quartile of 25-hydroxyvitamin D level.

CONCLUSIONS: They observed increasing risk of ischaemic heart disease, myocardial infarction, and early death with decreasing plasma 25-hydroxyvitamin D levels. These findings were substantiated in meta-analyses.

OBJECTIVE:  They tested the hypothesis that low plasma concentrations of 25-hydroxyvitamin D are associated with increased risk of symptomatic ischemic stroke in the general population.

METHODS: They measured plasma 25-hydroxyvitamin D in 10,170 individuals from the general population, the Copenhagen City Heart Study. During 21 years of follow-up, 1,256 and 164 persons developed ischemic and hemorrhagic stroke, respectively. In a meta-analysis of ischemic stroke, they included 10 studies, 58,384 participants, and 2,644 events.

RESULTS: Stepwise decreasing plasma 25-hydroxyvitamin D concentrations were associated with stepwise increasing risk of ischemic stroke both as a function of seasonally adjusted percentile categories and as a function of clinical categories of 25-hydroxyvitamin D (p for trend ≤ 2 × 10(-3) ). In a Cox regression model comparing individuals with plasma 25-hydroxyvitamin D concentrations between the 1st and 4th percentiles to individuals with 25-hydroxyvitamin D concentrations between the 50th and 100th percentiles, multivariate adjusted hazard ratio of ischemic stroke was 1.82 (95% confidence interval, 1.41-2.34). Comparing individuals with clinical categories of severe vitamin D deficiency (<25.0nmol/l [<10.0ng/ml]) to individuals with optimal vitamin D status (≥75.0nmol/l [≥30.0ng/ml]), the multivariate adjusted hazard ratio of ischemic stroke was 1.36 (1.09-1.70). 25-Hydroxyvitamin D concentrations were not associated with risk of hemorrhagic stroke. In a meta-analysis comparing lowest versus highest quartile of 25-hydroxyvitamin D concentrations, the multivariate adjusted odds ratio of ischemic stroke was 1.54 (1.43-1.65) with a corresponding hazard ratio of 1.46 (1.35-1.58) in prospective general population studies.

INTERPRETATION: In this large population-based prospective study, they observed stepwise increasing risk of symptomatic ischemic stroke with decreasing plasma 25-hydroxyvitamin D concentrations. This finding was substantiated in a meta-analysis.

"Who said this blog was only about MS? If we want to spread the message of a holistic approach to treating MS we need to cover all issues that may impact on your life? This includes vD supplementation. Do you mind doing another quick survey around vD supplementation in your country?"


Labels: , , ,