Background:
despite major advances in immunology and molecular biology, Multiple
Sclerosis is poorly
understood with regards to etiology and its immune trigger and causal
pathways are substantially unknown. In recent years, vascular abnormalities
associated with Multiple Sclerosis have been investigated, opening the doors to
the hypothesis that in the pathogenesis of multiple sclerosis a vascular
component could be important. Different forms of vascular abnormalities have
been associated with MS: increased risk for ischemic disease, cerebral
hypoperfusion,
abnormalities of endothelial cells and impaired venous drainage. The aim of
this review was to describe literature evidence concerning the correlation
between Multiple Sclerosis and vascular dysfunction, cardiovascular risk
factors and major cardiovascular events.
Methods:
A literature review was performed using the following databases and web
search engines: PubMed –
US National Library of Medicine; Google Scholar; and Ovid MEDLINE. The
search included the following combination of terms: “multiple sclerosis” and
endothelial dysfunction or vascular dysregulation or vascular hypothesis or risk
factors or cardiovascular disease or venous thromboembolism or epidemiology.
The selected articles were divided into six macro-groups according to the topic
of the paper: cardiovascular risk; cardiovascular diseases;
microcirculation factors; venous alterations; infectious pathogens; and
vascular adverse effects of therapy.
Results:
patients with Multiple Sclerosis
seem to have more cardiovascular risk factors and an increased risk for
ischemic stroke. Several studies have demonstrated cerebral perfusion
abnormalities. The relationship between the disturbances in cerebral venous
outflow and neurological disorders remains an open issue that requires further studies.
Conclusion:
Recent evidence suggests that vascular components may be initiating
triggers for neuronal
pathology and subsequent neurological manifestations of the disease. The
high degree of comorbidity between vascular disease and Multiple Sclerosis
suggests that vascular pathology may be an important factor causing neuronal
dysfunction or degeneration in multiple sclerosis