Neurocardiology Update: The Brain–Heart Connection in Multiple Sclerosis—A Narrative Review

Abstract

Background and Aims

While multiple sclerosis (MS) is primarily considered a neurological disorder, mounting evidence suggests a strong association with cardiovascular diseases (CVDs), impacting both disease progression and patient outcomes. This paper aims to raise awareness of this disease association while promoting a clinical-oriented, multidisciplinary approach that can provide long-term benefits for these patients.

Methods

A comprehensive literature review was conducted to gather up-to-date evidence concerning the incidence and type of CVDs associated with MS, the mechanisms underlying this disease association, as well as the impact on MS progression. Based on this evidence, a neurocardiological approach to MS in clinical practice was proposed.

Results

Past and present research agree on the high rates of arterial hypertension, metabolic syndrome, stroke, and myocardial infarction in people with MS. However, other prevalent comorbidities, such as venous thromboembolism and autonomic dysfunction may be easily overlooked in clinical practice. A complex interplay between genetic predisposition, traditional risk factors, autonomic dysfunction, inflammation, and treatment-related factors likely plays a role in promoting CVDs in MS. The impact of cardiovascular dysfunction on MS progression ranges from subclinical impairments, such as impaired axonal repairing, to overt physical disability and cognitive dysfunction. This paper proposes a neurocardiological approach to the daily clinical practice of MS patients, comprising general lifestyle measures, comorbidity screening at MS diagnosis, extensive work-ups for progressive/active forms, and selected autonomic dysfunction screening.

Conclusion

MS is a lifelong disorder that can be associated with a multitude of comorbidities, particularly cardiovascular ones. Along with increased mortality, cardiovascular pathology can adversely affect clinical and radiological-derived MS outcomes. Thus, surveillance and preventative measures are required for this population.