Abstract 4336917: Cardiovascular Risk in Patients with Multiple Sclerosis: A 10-year Matched Cohort Study

Background: Cardiovascular disease is a leading cause of morbidity and mortality worldwide, but its risk among patients with multiple sclerosis (MS) remains underexplored. This study aimed to evaluate the 10-year risk of acute coronary syndrome (ACS) in patients with MS compared to matched controls without MS. Methods: A retrospective cohort analysis was conducted using de-identified electronic health records from the TriNetX Global Collaborative Network, encompassing over 160 million patients from 143 healthcare organizations. Patients with MS (n=300,268) were matched 1:1 to controls without MS (n=584,256) based on age, sex, race, diabetes, hypertension, obesity, and tobacco use. After exclusions and matching, each cohort included 254,992 patients. Individuals with a prior history of heart failure, cardiomyopathy, chronic ischemic heart disease, or acute myocardial infarction were excluded. The primary outcome was ACS, defined as unstable angina or acute myocardial infarction (ICD-10-CM: I20.0, I21), assessed over a 10-year follow-up. Statistical analyses included risk estimates, Kaplan-Meier survival analysis, and Cox proportional hazards modeling. Results: Over 10 years, MS patients had significantly fewer ACS events (1,014 vs. 3,032) than controls. The risk of ACS was 0.4% in the MS cohort and 1.2% in controls (risk difference -0.008; p<0.001). The hazard ratio for ACS in MS patients was 0.44 (95% CI: 0.41–0.47), indicating a 56% lower risk than controls. Conclusions: Patients with MS had a significantly reduced risk of ACS over 10 years compared to matched controls. These findings suggest a potential cardioprotective effect from immunosuppressive therapies employed in MS and frequent medical monitoring in the MS population. The results of this study warrant further investigation to elucidate the mechanisms underlying the reduced cardiovascular risk observed in individuals with MS.