Incidence and associated outcomes of major adverse cardiovascular events in multiple sclerosis versus rheumatoid arthritis

AIMS: People with multiple sclerosis (pwMS) and rheumatoid arthritis (pwRA) have an increased cardiovascular disease (CVD) risk. As chronic inflammatory diseases with differing underlying mechanisms, they provide a useful comparison for understanding cardiovascular risk. We investigated major adverse cardiovascular event (MACE) incidence in pwMS, compared to pwRA. METHODS: A cohort study was conducted using anonymised healthcare data in TriNetX. PwMS or RA aged ≥55 years were diagnosed at least 5 years prior to the search and were 1:1 propensity-score matched for age, sex, ethnicity, pre-existing comorbidities, cardiovascular procedures and medications. Cox proportional hazard models determined 5-year incident MACE in pwMS, and associations between CVD risk factors and 5-year incident MACE were investigated. Associations were then compared between pwMS and pwRA. RESULTS: Among 147,933 pwMS, 8-12% experienced a MACE within 5-years of a recording of MS diagnosis in the database with or without CVD risk factors. PwMS and CVD risk factors, with no previously experienced MACEs, had a higher rate of MACE (HR 1.13, 95%CI 1.08, 1.19) compared to those without CVD risk factors. Among pwMS, a significantly higher rate of stroke (HR 1.28, 95% CI 1.22, 1.35) and all-cause mortality (HR 1.09, 95% CI 1.06, 1.12) was observed compared to pwRA. Normal CRP levels (<3mg/L) were associated with a lower rate of subsequent MACE compared to high CRP levels (≥3mg/L) (HR 0.62, 95% CI 0.58, 0.66) in pwMS. CONCLUSIONS: Major adverse cardiovascular events are relatively common in pwMS; those with CVD risk factors have a higher 5-year MACE incidence. PwMS had a higher rate of stroke and all-cause mortality compared to pwRA. CRP may be an important variable associated with future MACE in pwMS.