The burden of co-morbidities can be particularly high in patients with MS [1]. Whereas the rates of psychiatric co-morbidities seem largely stable with increasing age, the physical co-morbidities (e.g. hypertension, hyperlipidemia, diabetes) become more prevalent as MS patients get older [2,3] (see figure). According to Danish national registry data, the onset of vascular co-morbidities often occurs shortly after the diagnosis of MS [4].


Prevalence of hypertension among Canadian MS patients by age group [2,3]

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It is of note that in a recent study conducted in England [5] which compared matched populations with (n= 12,251) and without MS (n= 72,572), having the condition was associated with a:

  • 59% increased hazard of cerebrovascular disease 
  • 32% increased hazard of any macrovascular disease
  • 28% increased hazard of acute coronary syndrome
  • 1.5-fold increased hazard in cardiovascular disease mortality.


A higher risk of cardiovascular disease for patients with MS was noted even after accounting for traditional vascular risk factors [5]. While this observation needs further investigation, it seems it would not be unique to MS [6] since it has also been described for other immune-mediated and inflammatory diseases like psoriasis and rheumatoid arthritis [5].


Co-morbid conditions may influence disease outcomes, including relapses, disability progression or neurodegenerative tissue injury [2,3,6,7]. Additionally, co-morbidities may have other negative consequences such as diagnostic delays, increased mortality, or reduced quality of life [2,3].


Furthermore, the presence of co-morbidities appears to affect treatment decisions in MS. For example, an analysis of Canadian administrative data (n=10,698) found the likelihood of initiating a disease-modifying therapy decreased with increasing numbers of comorbid conditions [8].


Appropriate management of co-morbidities in the management of patients with MS is important [6].





Prof. Magd Zakaria

Management of MS: What if the burden of co-morbidities is high?



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