Incidence and Associated Outcomes of Major Adverse Cardiovascular Events in Multiple Sclerosis versus Rheumatoid Arthritis

France-Ratcliffe, M ORCID: 0000-0002-1239-2545, Harrison, SL, Verma, LA ORCID: 0000-0002-0392-1767, McDowell, G ORCID: 0000-0002-2880-5236, Abdul-Rahim, AH, McCallum, L, Young, CA and Buckley, BJR ORCID: 0000-0002-1479-8872 Incidence and Associated Outcomes of Major Adverse Cardiovascular Events in Multiple Sclerosis versus Rheumatoid Arthritis. Multiple Sclerosis and Related Disorders. ISSN 2211-0348 (Accepted)

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Abstract

Aims
People with multiple sclerosis (pwMS) and rheumatoid arthritis (pwRA) have an increased cardiovascular disease (CVD) risk. As chronic inflammatory diseases with differing underlying mechanisms, they provide a useful comparison for understanding cardiovascular risk. We investigated major adverse cardiovascular event (MACE) incidence in pwMS, compared to pwRA.
Methods
A cohort study was conducted using anonymised healthcare data in TriNetX. PwMS or RA aged ≥55 years were diagnosed at least 5 years prior to the search and were 1:1 propensity-score matched for age, sex, ethnicity, pre-existing comorbidities, cardiovascular procedures and medications. Cox proportional hazard models determined 5-year incident MACE in pwMS, and associations between CVD risk factors and 5-year incident MACE were investigated. Associations were then compared between pwMS and pwRA.
Results
Among 147,933 pwMS, 8-12% experienced a MACE within 5-years of a recording of MS diagnosis in the database with or without CVD risk factors. PwMS and CVD risk factors, with no previously experienced MACEs, had a higher rate of MACE (HR 1.13, 95%CI 1.08, 1.19) compared to those without CVD risk factors. Among pwMS, a significantly higher rate of stroke (HR 1.28, 95% CI 1.22, 1.35) and all-cause mortality (HR 1.09, 95% CI 1.06, 1.12) was observed compared to pwRA. Normal CRP levels (<3mg/L) were associated with a lower rate of subsequent MACE compared to high CRP levels (≥3mg/L) (HR 0.62, 95% CI 0.58, 0.66) in pwMS.
Conclusions
Major adverse cardiovascular events are relatively common in pwMS; those with CVD risk factors have a higher 5-year MACE incidence. PwMS had a higher rate of stroke and all-cause mortality compared to pwRA. CRP may be an important variable influencing future MACE in pwMS.

Item Type:	Article
Uncontrolled Keywords:	1109 Neurosciences; 3209 Neurosciences
Subjects:	R Medicine > RA Public aspects of medicine R Medicine > RC Internal medicine
Divisions:	Pharmacy and Biomolecular Sciences Sport and Exercise Sciences
Publisher:	Elsevier BV
Date of acceptance:	19 August 2026
Date of first compliant Open Access:	27 August 2026
Date Deposited:	27 Aug 2026 08:46
Last Modified:	27 Aug 2026 08:46
DOI or ID number:	10.1016/j.msard.2026.107674
URI:	https://researchonline.ljmu.ac.uk/id/eprint/29206

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