Findings from a systematic review and meta-analysis revealed an increased risk of myocardial infarction and heart failure in patients with multiple sclerosis (MS). The study was published in Multiple Sclerosis and Related Disorders.

Subgroup analysis revealed that the risk of heart disease was more predominant in women and younger individuals with MS. Women with MS had a 2.3-fold higher chance of myocardial infarction (133% higher risk) and 2.2-fold higher chance of heart failure (124% higher risk).

“Myocardial infarction and heart failure should be considered in people with multiple sclerosis during follow-up examinations,” the authors suggested.

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They speculated that accelerated biological aging or systemic inflammation and small vessel diseases present in individuals with MS provided possible explanations for higher incidences of cardiovascular disease. One study indicated increased cases of infectious myocarditis in individuals with MS, while another found an increased risk of acute coronary syndrome.

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Researchers reviewed 3 databases including Medline, Embase, and the Cochrane Controlled Register of Trials. They identified 5159 studies, 9 of which met the inclusion criteria for the systematic review and meta-analysis.

They performed the risk of bias assessment in 7 categories and rated each of the 9 remaining studies using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach, and the Risk Of Bias In Non-randomized Studies of Exposures (ROBINS-E) tool.

The total number of individuals with MS who participated in each study ranged from 4539 and 44,452 with ages ranging from 35 to 45 years, and the mean follow-up duration ranging from 2.7 to 11.3 years.

The overall risk of bias was high with 2 studies having a critical risk of bias, 5 with a serious risk of bias, and 2 with a moderate risk of bias.

Limitations of this study included high risk of bias, low number of included studies, localization of all included studies to Western countries, and lack of available data to investigate disease-modifying interventions and MS progression patterns related to cardiovascular events.

“The certainty of evidence of our meta-analyses was low or very low,” the authors noted.


Rapp D, Michels S, Schöpe J, Schwingshackl L, Tumani H, Senel M. Associations between multiple sclerosis and incidence of heart diseases: systematic review and meta-analysis of observational studies. Mult Scler Relat Disord. 2021;56:103279. doi:10.1016/j.msard.2021.103279