The burden of co-morbidities can be particularly high in patients with MS . 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 .
Prevalence of hypertension among Canadian MS patients by age group [2,3]
It is of note that in a recent study conducted in England  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 . While this observation needs further investigation, it seems it would not be unique to MS  since it has also been described for other immune-mediated and inflammatory diseases like psoriasis and rheumatoid arthritis .
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 .
Appropriate management of co-morbidities in the management of patients with MS is important .
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