Abstract WP479: Associations Between Vascular Risk, Amyloid Burden and Incident Dementia: The ARIC-PET Study

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Rebecca F Gottesman ◽  
Aozhou Wu ◽  
Josef Coresh ◽  
Clifford R Jack ◽  
David S Knopman ◽  
...  
Keyword(s):  
Risk Factors ◽  
Proportional Hazards ◽  
Brain Mri ◽  
Amyloid Β ◽  
Standardized Uptake Value ◽  
Cox Proportional Hazards ◽  
Vascular Risk ◽  
Brain Volumes ◽  
Dementia Risk ◽  
Incident Dementia

Background: Midlife vascular risk factors (MVRF) are associated with incident dementia. Similarly, amyloid β(Aβ) and neurodegeneration (e.g.brain volumes), as parts of the Alzheimer’s Disease (AD) ATN framework, are associated with cognition. Whether vascular and AD-associated factors contribute to dementia independently or interact synergistically to reduce cognitive ability is not well understood. Methods: Recruited from 3 U.S. communities, ARIC-PET participants were followed from 1987-89 (45-64 yo) through 2016-17 (74-94 yo). Cognition was evaluated in 2011-13 (ages 69-88), and twice more, every 2-3 years. In 2011-13, nondemented ARIC-PET participants had a brain MRI, with measurement of white matter hyperintensities (WMH) and brain volumes, with florbetapir (Aβ) PET scans in 2012-14; global cortical standardized uptake value ratio (SUVR) was log-transformed and standardized. Dementia was classified by expert review, as well as phone and medical record surveillance. The relative contributions of vascular risk (MVRF, WMH volume) and AD pathology (elevated Aβ SUVR, smaller AD signature region volumes) to incident dementia were evaluated with Cox proportional hazards regression. Results: In 298 individuals, 36 developed dementia. In models with key MVRF, demographics, and Aβ SUVR, hypertension and Aβ each independently predicted dementia risk (per SD of Aβ SUVR: HR 2.57, 95% CI 1.72-3.84; hypertension: HR 2.57, 95% CI 1.16-5.67), but didn’t interact on dementia risk. WMH (per SD: HR 1.51, 95% CI 1.03-2.20) and Aβ SUVR (per SD: HR 2.52, 95% CI 1.83-3.47) each contributed to incident dementia but WMH lost significance when MVRF were added to the model. Smaller AD signature regions were associated with incident dementia, independent of Aβ SUVR, and remained significant after adjustment for MVRF (HR per SD 2.18, 95% CI 1.18-4.01). Conclusions: Midlife hypertension and late-life Aβ independently contribute to dementia risk, but don’t synergize on a multiplicative scale. Neurodegeneration (e.g.smaller AD signature region volume) is also associated with incident dementia, independent of Aβ and MVRF. Multiple pathways leading to dementia should be considered when evaluating risk factors and interventions to reduce the burden of dementia.

scholarly journals Hypertension and Hypercholesterolemia Modify Dementia Risk in Relation to APOE ɛ4 Status

2021 ◽  
pp. 1-12
Author(s):  
Jagan A. Pillai ◽  
Kou Lei ◽  
James Bena ◽  
Lisa Penn ◽  
James B. Leverenz
Keyword(s):  
Risk Factors ◽  
Lower Risk ◽  
Proportional Hazards ◽  
Age Groups ◽  
Cox Proportional Hazards ◽  
Vascular Risk Factors ◽  
Vascular Risk ◽  
Cox Proportional Hazards Models ◽  
Dementia Risk ◽  
Dementia Onset

Background: There is significant interest in understanding the role of modifiable vascular risk factors contributing to dementia risk across age groups. Objective: Risk of dementia onset was assessed in relation to vascular risk factors of hypertension and hypercholesterolemia among cognitively normal APOE ɛ4 carriers and non-carriers. Methods: In a sample of prospectively characterized longitudinal cohort from the National Alzheimer’s Coordinating Center database, 9,349 participants met criteria for normal cognition at baseline, had a CDR-Global (CDR-G) score of zero, and had concomitant data on APOE ɛ4 status and medical co-morbidities including histories of hypertension and hypercholesterolemia. Multivariable Cox proportional hazards models adjusted for well-known potential confounders were used to compare dementia onset among APOE ɛ4 carriers and non-carriers by young (≤65 years) and old (>  65 year) age groups. Results: 519 participants converted to dementia within an average follow up of 5.97 years. Among older APOE ɛ4 carriers, hypercholesterolemia was related to lower risk of dementia (HR (95% CI), 0.68 (0.49–0.94), p = 0.02). Among older APOE ɛ4 non-carriers, hypertension was related to higher risk of dementia (HR (95% CI), 1.44 (1.13–1.82), p = 0.003). These results were corroborated among a subset with autopsy data characterizing underlying neuropathology. Among younger participants, vascular risk factors did not impact dementia risk, likely from a lower frequency of vascular and Alzheimer’s as etiologies of dementia among this cohort. Conclusion: A history of hypercholesterolemia related to a lower risk of dementia among older APOE ɛ4 carriers, while hypertension related to a higher risk of dementia among older APOE ɛ4 non-carriers.

scholarly journals Bi-directional association between epilepsy and dementia

Neurology ◽  
2020 ◽  
Vol 95 (24) ◽  
pp. e3241-e3247 ◽  
Author(s):  
Maria Stefanidou ◽  
Alexa S. Beiser ◽  
Jayandra Jung Himali ◽  
Teng J. Peng ◽  
Orrin Devinsky ◽  
...  
Keyword(s):  
Proportional Hazards ◽  
Secondary Analysis ◽  
Cox Proportional Hazards ◽  
Dementia Risk ◽  
Incident Dementia ◽  
Heart Study ◽  
Allele Status ◽  
Ε4 Allele ◽  
Nested Case Control

ObjectiveTo assess the risk of incident epilepsy among participants with prevalent dementia and the risk of incident dementia among participants with prevalent epilepsy in the Framingham Heart Study (FHS).MethodsWe analyzed prospectively collected data in the Original and Offspring FHS cohorts. To determine the risk of developing epilepsy among participants with dementia and the risk of developing dementia among participants with epilepsy, we used separate, nested, case–control designs and matched each case to 3 age-, sex- and FHS cohort–matched controls. We used Cox proportional hazards regression analysis, adjusting for sex and age. In secondary analysis, we investigated the role of education level and APOE ε4 allele status in modifying the association between epilepsy and dementia.ResultsA total of 4,906 participants had information on epilepsy and dementia and dementia follow-up after age 65. Among 660 participants with dementia and 1,980 dementia-free controls, there were 58 incident epilepsy cases during follow-up. Analysis comparing epilepsy risk among dementia cases vs controls yielded a hazard ratio (HR) of 1.82 (95% confidence interval 1.05–3.16, p = 0.034). Among 43 participants with epilepsy and 129 epilepsy-free controls, there were 51 incident dementia cases. Analysis comparing dementia risk among epilepsy cases vs controls yielded a HR of 1.99 (1.11–3.57, p = 0.021). In this group, among participants with any post–high school education, prevalent epilepsy was associated with a nearly 5-fold risk for developing dementia (HR 4.67 [1.82–12.01], p = 0.001) compared to controls of the same educational attainment.ConclusionsThere is a bi-directional association between epilepsy and dementia. with either condition carrying a nearly 2-fold risk of developing the other when compared to controls.

scholarly journals Illiteracy, dementia risk, and cognitive trajectories among older adults with low education

Neurology ◽  
2019 ◽  
Vol 93 (24) ◽  
pp. e2247-e2256 ◽  
Author(s):  
Miguel Arce Rentería ◽  
Jet M.J. Vonk ◽  
Gloria Felix ◽  
Justina F. Avila ◽  
Laura B. Zahodne ◽  
...  
Keyword(s):  
Older Adults ◽  
Cognitive Decline ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Independent Effect ◽  
Growth Curve Models ◽  
Cox Proportional Hazards Models ◽  
Dementia Risk ◽  
Incident Dementia ◽  
Low Education

ObjectiveTo investigate whether illiteracy was associated with greater risk of prevalent and incident dementia and more rapid cognitive decline among older adults with low education.MethodsAnalyses included 983 adults (≥65 years old, ≤4 years of schooling) who participated in a longitudinal community aging study. Literacy was self-reported (“Did you ever learn to read or write?”). Neuropsychological measures of memory, language, and visuospatial abilities were administered at baseline and at follow-ups (median [range] 3.49 years [0–23]). At each visit, functional, cognitive, and medical data were reviewed and a dementia diagnosis was made using standard criteria. Logistic regression and Cox proportional hazards models evaluated the association of literacy with prevalent and incident dementia, respectively, while latent growth curve models evaluated the effect of literacy on cognitive trajectories, adjusting for relevant demographic and medical covariates.ResultsIlliterate participants were almost 3 times as likely to have dementia at baseline compared to literate participants. Among those who did not have dementia at baseline, illiterate participants were twice as likely to develop dementia. While illiterate participants showed worse memory, language, and visuospatial functioning at baseline than literate participants, literacy was not associated with rate of cognitive decline.ConclusionWe found that illiteracy was independently associated with higher risk of prevalent and incident dementia, but not with a more rapid rate of cognitive decline. The independent effect of illiteracy on dementia risk may be through a lower range of cognitive function, which is closer to diagnostic thresholds for dementia than the range of literate participants.

scholarly journals Association of Type 2 Diabetes, According to the Number of Risk Factors Within Target Range, With Structural Brain Abnormalities, Cognitive Performance, and Risk of Dementia

2021 ◽  
Author(s):  
April C.E. van Gennip ◽  
Coen D.A. Stehouwer ◽  
Martin P.J. van Boxtel ◽  
Frans R.J. Verhey ◽  
Annemarie Koster ◽  
...  
Keyword(s):  
Risk Factors ◽  
Type 2 Diabetes ◽  
Cognitive Performance ◽  
Target Range ◽  
Brain Abnormalities ◽  
Brain Volumes ◽  
Dementia Risk ◽  
Incident Dementia

<b>Objective </b>Type 2 diabetes is associated with increased risks of cognitive dysfunction and brain abnormalities. The extent to which risk factor modification can mitigate these risks is unclear. We investigated the associations between incident dementia, cognitive performance and brain abnormalities among individuals with type 2 diabetes, according to the number of risk factors on target, compared to controls without diabetes. <div><p><b>Research Design and Methods</b> Prospective data from UK Biobank of 87,856 individuals (n=10,663 diabetes/n=77,193 controls; baseline 2006-2010; dementia follow-up until February, 2018). Individuals with diabetes were categorized according to the number of seven selected risk factors within guideline-recommended target range (nonsmoking; guideline-recommended levels of HbA1c, blood pressure, BMI, albuminuria, physical activity, diet). Outcomes were incident dementia, domain-specific cognitive performance, white matter hyperintensities and total brain volume.</p> <p><b>Results </b>After a mean follow-up of 9.0 years, 147(1.4%) individuals with diabetes and 412(0.5%) controls had incident dementia. Among individuals with diabetes, excess dementia risk decreased stepwise for a higher number of risk factors on target. Compared to controls (incidence rate per 1,000 person-years 0.62(95%CI:0.56;0.68)), individuals with diabetes who had 5-7 risk factors on target had no significant excess dementia risk (absolute rate difference per 1,000 person-years 0.20(-0.11;0.52); HR:1.32(0.89;1.95)). Similarly, differences in processing speed, executive function, and brain volumes were progressively smaller for a higher number of risk factors on target; these results were replicated in the Maastricht Study.</p> <p><b>Conclusions </b>Among individuals with diabetes, excess dementia risk, lower cognitive performance and brain abnormalities decreased stepwise for a higher number of risk factors on target.</p></div>

scholarly journals Periodontal disease and incident dementia

Neurology ◽  
2020 ◽  
Vol 95 (12) ◽  
pp. e1660-e1671
Author(s):  
Ryan T. Demmer ◽  
Faye L. Norby ◽  
Kamakshi Lakshminarayan ◽  
Keenan A. Walker ◽  
James S. Pankow ◽  
...  
Keyword(s):  
Periodontal Disease ◽  
Proportional Hazards ◽  
Brain Mri ◽  
Cox Proportional Hazards ◽  
Incidence Density ◽  
Adjusted Risk ◽  
Cox Proportional Hazards Models ◽  
Incident Dementia ◽  
Increased Risk ◽  
Combined Dementia

ObjectiveTo test the hypothesis that periodontal disease would be associated with increased risk for dementia and mild cognitive impairment (MCI) by assessing dementia/MCI outcomes after a baseline periodontal examination.MethodsParticipants enrolled in the Atherosclerosis Risk in Communities study with a clinical periodontal examination (or edentulous participants) at visit 4 (1996–1998; mean ± SD age 63 ± 6 years, 55% female, 21% black) and adjudicated dementia outcomes through 2016 were included (n = 8,275). A subgroup of 4,559 participants had adjudicated dementia and MCI assessments at visit 5 (2011–2013). Participants received a full-mouth periodontal examination and were classified into periodontal profile classes (PPCs) based on the severity and extent of gingival inflammation and attachment loss. MCI and dementia were determined via neurocognitive testing, neurological examination and history, informant interviews, and brain MRI in a subset. Cox proportional hazards models regressed incident dementia on PPCs. Relative risk regression models were used for the composite of MCI/dementia.ResultsThe cumulative incidence and incidence density of dementia during follow-up (average 18.4 years) were 19% (n = 1,569) and 11.8 cases per 1,000 person-years. Multivariable adjusted hazard ratios for incident dementia among participants with severe PPC or edentulism (vs periodontal healthy) were 1.22 (95% confidence interval [CI] 1.01–1.47) and 1.21 (95% CI 0.99–1.48), respectively. For the combined dementia/MCI outcome, adjusted risk ratios among participants with mild/intermediate PPC, severe PPC, or edentulism (vs periodontal healthy) were 1.22 (95% CI 1.00–1.48), 1.15 (95% CI 0.88–1.51), and 1.90 (95% CI 1.40–2.58). Results were stronger among younger (≤62 years) participants (p for interaction = 0.02).ConclusionPeriodontal disease was modestly associated with incident MCI and dementia in a community-based cohort of black and white participants.

scholarly journals Loneliness and Risk of Dementia

2018 ◽  
Vol 75 (7) ◽  
pp. 1414-1422 ◽  
Author(s):  
Angelina R Sutin ◽  
Yannick Stephan ◽  
Martina Luchetti ◽  
Antonio Terracciano
Keyword(s):  
Risk Factors ◽  
Social Isolation ◽  
Genetic Risk ◽  
Proportional Hazards ◽  
Genetic Risk Factors ◽  
Cognitive Status ◽  
Cox Proportional Hazards ◽  
Dementia Risk ◽  
Increased Risk ◽  
Modifiable Factor

Abstract Objective The present study tests whether loneliness is associated with risk of dementia in the largest sample to date and further examines whether the association is independent of social isolation, a related but independent component of social integration, and whether it varies by demographic factors and genetic vulnerability. Method Participants from the Health and Retirement Study (N = 12,030) reported on their loneliness, social isolation, and had information on clinical, behavioral, and genetic risk factors. Cognitive status was assessed at baseline and every 2 years over a 10-year follow-up with the modified Telephone Interview for Cognitive Status (TICSm). A TICSm score of 6 or less was indicative of dementia. Results Cox proportional hazards regression indicated that loneliness was associated with a 40% increased risk of dementia. This association held controlling for social isolation, and clinical, behavioral, and genetic risk factors. The association was similar across gender, race, ethnicity, education, and genetic risk. Discussion Loneliness is associated with increased risk of dementia. It is one modifiable factor that can be intervened on to reduce dementia risk.

scholarly journals Blood pressure from mid‐ to late life and risk of incident dementia

Neurology ◽  
2017 ◽  
Vol 89 (24) ◽  
pp. 2447-2454 ◽  
Author(s):  
Emer R. McGrath ◽  
Alexa S. Beiser ◽  
Charles DeCarli ◽  
Kendra L. Plourde ◽  
Ramachandran S. Vasan ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Systolic Hypertension ◽  
Proportional Hazards ◽  
Late Life ◽  
Cox Proportional Hazards ◽  
Elevated Blood Pressure ◽  
Elevated Blood ◽  
Dementia Risk ◽  
Incident Dementia ◽  
Steep Decline

Objective:To determine the association between blood pressure during midlife (40–64 years) to late life (≥65 years) and risk of incident dementia.Methods:This study included 1,440 (758 women, mean age 69 ± 6 years) Framingham Offspring participants who were free of dementia and attended 5 consecutive examinations at 4-year intervals starting at midlife (1983–1987, mean age 55 years) until late life (1998–2001, mean 69 years) and subsequently were followed up for incident dementia (mean 8 years). We determined the effect of midlife hypertension (≥140/90 mm Hg), late life hypertension, lower late life blood pressure (<100/70 mm Hg), persistence of hypertension during mid- to late life, and steep decline in blood pressure from mid- to late life over an 18-year exposure period.Results:During the follow-up period, 107 participants (71 women) developed dementia. Using multivariable Cox proportional hazards models, we found that midlife systolic hypertension (hazard ratio [HR] 1.57, 95% confidence interval [CI] 1.05–2.35) and persistence of systolic hypertension into late life (HR 1.96, 95% CI 1.25–3.09) were associated with an elevated risk of incident dementia. However, in individuals with low to normal blood pressure (≤140/90 mm Hg) at midlife, a steep decline in systolic blood pressure during mid- to late life was also associated with a >2-fold increase in dementia risk (HR 2.40, 95% CI 1.39–4.15).Conclusions:Elevated blood pressure during midlife, persistence of elevated blood pressure into late life, and, among nonhypertensives, a steep decline in blood pressure during mid- to late life were associated with an increased dementia risk in a community-based cohort. Our data highlight the potential sustained cognitive benefits of lower blood pressures in midlife but also suggest that declining blood pressure in older adults with prehypertension or normotension, but not in those with hypertension, may be a risk marker for dementia.

Abstract TP177: Long-term Stroke Risk in Patients Diagnosed with Hypertensive Encephalopathy

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Michael P Lerario ◽  
Alexander E Merkler ◽  
Gino Gialdini ◽  
Neal S Parikh ◽  
Gary L Bernardini ◽  
...  
Keyword(s):  
Risk Factors ◽  
Proportional Hazards ◽  
Hypertensive Encephalopathy ◽  
Cox Proportional Hazards ◽  
Vascular Risk Factors ◽  
Misclassification Error ◽  
Rank Test ◽  
Vascular Risk ◽  
Comorbidity Index

Introduction: The long-term cerebrovascular consequences of hypertensive encephalopathy (HE) are poorly understood. Therefore, we aimed to measure the risk of stroke following HE. Methods: We identified all adult patients discharged from nonfederal acute care hospitals between 2005 and 2013 in New York with a primary ICD-9-CM discharge diagnosis of HE (437.2). Only patients who underwent magnetic resonance imaging were included to reduce the likelihood of misclassification error. Patients with all other forms of hypertension (401-405), without concomitant codes for HE or cerebrovascular disease (430-438), served as controls. The primary outcome was incident stroke (431, 433.x1, 434.x1, or 436 in the absence of hemorrhage, trauma, or rehabilitation codes). Kaplan-Meier survival analysis was used to calculate cumulative rates of incident stroke and Cox proportional hazards analysis was used to determine the association between HE and incident stroke while adjusting for demographics, vascular risk factors, and the Elixhauser comorbidity index. Results: We identified 1,386 patients with HE and 2,869,873 with hypertension. Over a mean follow-up period of 3.3 (+/-1.8) years, we identified 66,594 ischemic and 12,343 hemorrhagic strokes. After 5 years, the cumulative rate of stroke was 7.8% (95% CI, 6.2-9.9%) in patients with HE and 3.2% (95% CI, 3.2-3.2%; P<0.001 for the log-rank test) in patients with any other hypertensive disease. After adjusting for demographics, vascular risk factors, and the Elixhauser comorbidity index, HE was independently associated with incident stroke (hazard ratio, 1.9; 95% CI, 1.5-2.4) as compared to controls. This association was similar when considering ischemic and hemorrhagic stroke separately. Conclusions: Patients discharged after HE face a higher long-term risk of subsequent stroke than patients without prior neurological complications of hypertension.

Abstract TP165: Associations Between Parkinson Disease and Stroke

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Benjamin R Kummer ◽  
Ashley E Aaroe ◽  
Hooman Kamel ◽  
Costantino Iadecola ◽  
Babak B Navi
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Parkinson Disease ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Vascular Risk Factors ◽  
Annual Incidence ◽  
Vascular Risk ◽  
Medicare Beneficiaries ◽  
The Relationship

Introduction: Cerebral ischemia and vascular risk factors are associated with the development of Alzheimer disease (AD). While Parkinson disease (PD) is also a common neurodegenerative condition, the relationship between ischemic stroke and PD remains unclear. Some evidence suggests a shared pathogenic pathway between both diseases. Methods: We used inpatient and outpatient claims data from 2008-2014 in a 5% sample of Medicare beneficiaries ≥66 years of age. Our variables of interest were: 1) a hospital-based diagnosis of ischemic stroke and 2) an outpatient or hospital-based diagnosis of idiopathic PD. Previously validated ICD-9-CM code algorithms were used to identify all diagnoses. We used Cox proportional hazards modeling to characterize the relationship between ischemic stroke and PD, while adjusting for demographics and vascular risk factors. We assessed both the association between PD and subsequent stroke, as well as stroke and subsequent PD. In a separate but identically designed set of analyses, we characterized the relationship between ischemic stroke and AD as a point of comparison. Results: Our analysis encompassed nearly 1.6 million patients with a mean age of 73(+/- 8) years, of whom 57% were female. The annual incidence of ischemic stroke was 1.75% (95% confidence interval [CI], 1.67-1.85%) after a diagnosis of PD versus 0.96% (95% CI, 0.96-0.97%) in those without PD (adjusted hazard ratio [aHR], 1.25; 95% CI, 1.19-1.32). In contrast, the annual incidence of ischemic stroke was 1.96% (95% CI, 1.89-2.03%) after a diagnosis of AD versus 0.96% (95% CI, 0.96-0.97%) in those without AD (aHR, 0.98; 95% CI, 0.95-1.02). The annual incidence of PD was 0.97% (95% CI, 0.92-1.03%) after ischemic stroke versus 0.39% (95% CI, 0.38-0.39%) in those without ischemic stroke (aHR, 1.62; 95% CI, 1.53-1.72). In contrast, the annual incidence of AD was 3.66% (95% CI, 3.56-3.78%) after a diagnosis of ischemic stroke versus 1.17% (95% CI, 1.16-1.17%) in those without ischemic stroke (aHR, 1.67; 95% CI, 1.61-1.72). Conclusions: Among Medicare beneficiaries, the relationships between stroke and PD were similar to those between stroke and AD. As in AD, a link may exist between cerebrovascular disease and PD.

Traditional risk factors may not explain increased incidence of myocardial infarction in MS

Neurology ◽  
2019 ◽  
Vol 92 (14) ◽  
pp. e1624-e1633 ◽  
Author(s):  
Ruth Ann Marrie ◽  
Allan Garland ◽  
Stephen Allan Schaffer ◽  
Randy Fransoo ◽  
Stella Leung ◽  
...  
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Proportional Hazards ◽  
Meta Analysis ◽  
Case Definition ◽  
Cox Proportional Hazards ◽  
Vascular Risk Factors ◽  
Health Claims ◽  
Vascular Risk ◽  
Health Claims Data

ObjectiveTo compare the risk of incident acute myocardial infarction (AMI) in the multiple sclerosis (MS) population and a matched population without MS, controlling for traditional vascular risk factors.MethodsWe conducted a retrospective matched cohort study using population-based administrative (health claims) data in 2 Canadian provinces, British Columbia and Manitoba. We identified incident MS cases using a validated case definition. For each case, we identified up to 5 controls without MS matched on age, sex, and region. We compared the incidence of AMI between cohorts using incidence rate ratios (IRR). We used Cox proportional hazards regression to compare the hazard of AMI between cohorts adjusting for sociodemographic factors, diabetes, hypertension, and hyperlipidemia. We pooled the provincial findings using meta-analysis.ResultsWe identified 14,565 persons with MS and 72,825 matched controls. The crude incidence of AMI per 100,000 population was 146.2 (95% confidence interval [CI] 129.0–163.5) in the MS population and 128.8 (95% CI 121.8–135.8) in the matched population. After age standardization, the incidence of AMI was higher in the MS population than in the matched population (IRR 1.18; 95% CI 1.03–1.36). After adjustment, the hazard of AMI was 60% higher in the MS population than in the matched population (hazard ratio 1.63; 95% CI 1.43–1.87).ConclusionThe risk of AMI is elevated in MS, and this risk may not be accounted for by traditional vascular risk factors.

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