Outcomes and Management of Acute Myocardial Infarction in Multiple Sclerosis: 'Heart-MS
Aim 1. To examine the risk of incident acute myocardial infarction, controlling for traditional cardiovascular risk factors among the MS population as compared to the general population.
Hypotheses: The incidence of AMI, is higher in young adults with MS than in those without MS, but the incidence of AMI does not differ in older adults with and without MS. Traditional cardiovascular risk factors do not fully account for the disparity in the risk of AMI among young adults with MS as compared to those without MS. Rationale: Our preliminary data suggest that the incidence of IHD is higher in an incident MS population than in an age-, sex- and geographically-matched population. In other chronic immune-mediated diseases, including psoriasis and rheumatoid arthritis, the increased risk of IHD is not fully explained by traditional cardiovascular risk factors.
Aim 2. To compare management (pharmacotherapy, cardiac catheterization, revascularization) after acute myocardial infarction in the MS and general populations.
Hypotheses: Catheterization and revascularization rates after AMI are lower in the MS population than in the general population after AMI, and pharmacotherapy use is also lower. Rationale: Our preliminary data suggest that Manitobans with MS are less likely to be hospitalized for revascularization. Further, revascularization rates are lower after AMI in rheumatoid arthritis.
Aim 3. To compare outcomes (mortality, cardiac admissions) after acute myocardial infarction in the MS and general populations.
Hypothesis: Mortality after AMI is higher in the MS population than in the general population. Rationale: Mortality after intensive care unit admission is higher in the MS population than a matched population, adjusting for age, sex, socioeconomic status, comorbidity, and severity of critical illness. Further, mortality rates are higher after AMI in rheumatoid arthritis.