Abstract WMP55: Increased Risk of Acute Ischemic Stroke in Multiple Sclerosis: Analysis of a Large National Cohort

Abstract

Background: The advent of mechanical thrombectomy in acute stroke care has reignited interest in the arena of neuro-inflammation and neuro-plasticity to optimize stroke management and further improve outcome. Even though there is an early evidence suggesting increased risk of ischemic stroke (IS) in pro-inflammatory states like lupus, rheumatoid and even multiple sclerosis, cardiovascular risk factor association has yet to be comprehensively studied in Multiple Sclerosis (MS). This is the first ever North American Study focusing on prevalence of ischemic stroke in the largest MS cohort. Method: This retrospective study included all patients diagnosed with MS from 2000 to 2016, identified using ICD-9/10 codes. The data were extracted from the Cerner's Health Facts database. From the pool of MS patients, IS was identified and their comorbidities are identified. Multiple logistic regression was used to evaluate the odds of having IS in patients with MS. Statistical analysis performed by the SAS v ersion 9.4, Cary, NC, USA. Result: A total of 83,222 patients with a diagnosis of MS were identified. IS was officially diagnosed in 2,159 (2.59%) and intracerebral hemorrhage (ICH) in 191 (0.22%) patients with MS. Patients with MS had 1.6 times more likelihood of having an IS as compared to non-MS patients (p<0.0001). The study identified the presence of vascular risk factors in the patients with MS. Patients who had MS and had ages between 41-64 (OR 1.75, CI 1.51-2.03), hypertension (OR 4.77, CI 4.201-5.412), Coronary Artery Disease (OR 2.09, CI 1.843-2.380), heart failure (OR 1.38, CI 1.175-1.621), atrial fibrillation (OR 1.61, CI 1.361-1.894), diabetes mellitus (OR 1.58, CI 1.40-1.76), peripheral vascular disease (OR 2.38, CI 1.90-2.98), and smoking (OR 1.29, CI 1.15-1.45) were more likely to have an IS as compared to those who did not have MS and these risk factors. Conclusion: This is one of the largest MS cohort studies confirming prior reports of higher incidence of IS in MS population, especially in the 41-64 age group, after adjusting for cardiovascular risk factors. Future prospective epidemiological and molecular studies can open new diagnostic and treatment avenues.