多发性硬化症确诊后的血管风险轨迹和管理:1987年至2018年间英国一项基于人群的匹配队列研究。

IF 4.8 2区 医学 Q1 CLINICAL NEUROLOGY Multiple Sclerosis Journal Pub Date : 2024-10-17 DOI:10.1177/13524585241287388
Raffaele Palladino, Jeremy Chataway, Mekha Mathew, Azeem Majeed, Ruth Ann Marrie
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引用次数: 0

摘要

背景:多发性硬化症患者(PwMS)的心脑血管疾病负担加重,但血管风险因素管理可减轻这一负担:我们比较了多发性硬化症确诊后多发性硬化症患者与普通人群的血管风险因素、血管合并症和临床管理轨迹,同时控制了虚弱程度:利用1987年至2018年期间临床实践研究数据链中的英国数据进行回顾性纵向分析,包括根据年龄、性别和全科实践与最多六名无MS的对照者进行匹配的PwMS:我们将 12251 名 PwMS 与 72572 名匹配对照进行了比较;3.8% 的 PwMS 患有轻度-中度虚弱,比匹配对照高出 1.2%。与对照组相比,PwMS 患 2 型糖尿病(HR 1.18,95% CI (1.04, 1.34))和开始服用降压药(HR 1.40,95% CI (1.33, 1.47))的比例较高。在基线时患有高血压的人群中,PwMS 和对照组之间的血压轨迹没有差异。高血压管理目标的达标率(HR 1.25,95% CI (1.12,1.41))增加了:与匹配的对照组相比,患有高血压的家庭主妇更有可能达到治疗目标,这一观察结果令人鼓舞,但血管合并症发生率的升高表明,可能需要对这一人群进行更严格的血管管理。
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Trajectories and management of vascular risk following the diagnosis of multiple sclerosis: A population-based matched cohort study between 1987 and 2018 in England.

Background: People with multiple sclerosis (PwMS) have an increased cardiovascular and cerebrovascular disease burden, but this could be mitigated by vascular risk factor management.

Objectives: We compared the trajectories of vascular risk factors, vascular comorbidities and clinical management in PwMS against the general population post-MS diagnosis while controlling for frailty.

Methods: Retrospective longitudinal analysis using English data from the Clinical Practice Research Datalink between 1987 and 2018 comprising PwMS matched with up to six controls without MS by age, sex and general practice.

Results: We compared 12,251 PwMS with 72,572 matched controls; 3.8% of PwMS had mild-moderate frailty, 1.2% more than matched controls. Compared to controls, PwMS had an elevated incidence of Type 2 diabetes (HR 1.18, 95% CI (1.04, 1.34)), and starting antihypertensive medications (HR 1.40, 95% CI (1.33, 1.47)). Among those with hypertension at baseline, blood pressure trajectories did not differ between PwMS and controls. PwMS had increased rates of meeting targets for hypertension management (HR 1.25, 95% CI (1.12, 1.41)).

Conclusion: The observation that PwMS with hypertension are more likely to meet treatment targets than matched controls is encouraging, but the elevated rates of vascular comorbidities suggest that tighter vascular management may be needed in this population.

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来源期刊
Multiple Sclerosis Journal
Multiple Sclerosis Journal 医学-临床神经学
CiteScore
10.90
自引率
6.90%
发文量
186
审稿时长
3-8 weeks
期刊介绍: Multiple Sclerosis Journal is a peer-reviewed international journal that focuses on all aspects of multiple sclerosis, neuromyelitis optica and other related autoimmune diseases of the central nervous system. The journal for your research in the following areas: * __Biologic basis:__ pathology, myelin biology, pathophysiology of the blood/brain barrier, axo-glial pathobiology, remyelination, virology and microbiome, immunology, proteomics * __Epidemology and genetics:__ genetics epigenetics, epidemiology * __Clinical and Neuroimaging:__ clinical neurology, biomarkers, neuroimaging and clinical outcome measures * __Therapeutics and rehabilitation:__ therapeutics, rehabilitation, psychology, neuroplasticity, neuroprotection, and systematic management Print ISSN: 1352-4585
期刊最新文献
Erratum to "Ofatumumab-induced severe reactivation of psoriasis in a patient with multiple sclerosis" Multiple Sclerosis Journal; 2024: 30(8); 1086-1088. DOI: 10.1177/13524585241260564. Phenotyping in vivo chronic inflammation in multiple sclerosis by combined 11C-PBR28 MR-PET and 7T susceptibility-weighted imaging. Using serum neurofilament-light in clinical practice: Growing enthusiasm that may need bridling. Multiple sclerosis subgroups: Data-driven clusters based on patient-reported outcomes and a large clinical sample. Trajectories and management of vascular risk following the diagnosis of multiple sclerosis: A population-based matched cohort study between 1987 and 2018 in England.
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