title: A systematic review of the incidence and prevalence of cardiac, cerebrovascular, and peripheral vascular disease in multiple sclerosis.
abstract: BACKGROUND
  Findings regarding the prevalence of vascular comorbidities in multiple sclerosis (MS) are conflicting.
  
  
  OBJECTIVE
  The objective of this review is to estimate the incidence and prevalence of vascular comorbidities and predisposing comorbidities in persons with MS and to assess the quality of the included studies.
  
  
  METHODS
  The PubMed, EMBASE, SCOPUS and Web of Knowledge databases, conference proceedings, and reference lists of retrieved articles were searched. One reviewer abstracted data using a standardized data collection form, while the second reviewer verified the abstraction. Included studies were assessed qualitatively. Quantitatively, we assessed studies using the I² statistic, and conducted meta-analyses for population-based studies only.
  
  
  RESULTS
  The prevalence of hypertension and hyperlipidemia exceeded 10% in the MS population and increased with age. While the prevalence of ischemic heart disease, congestive heart failure, and stroke were less than 5% overall, the prevalence of these conditions exceeded expectations when compared to the general population. Cardiac valvular disease, however, affected the MS population less often than expected. Problems with study quality were common.
  
  
  CONCLUSIONS
  Despite the relatively high prevalence of some vascular comorbidities in the MS population, important gaps exist in our understanding of their epidemiology. Most of our knowledge is based on studies conducted in a small number of regions.
authors.affiliation: Department of Internal Medicine, University of Manitoba, Canada/Department of Community Health Sciences, University of Manitoba, Canada rmarrie@hsc.mb.ca.
authors.forename: Ruth Ann
authors.initials: RA
authors.lastname: Marrie
authors.affiliation: Department of Internal Medicine, University of Manitoba, Canada.
authors.forename: Nadia
authors.initials: N
authors.lastname: Reider
authors.affiliation: Mellen Center for MS Treatment and Research, Cleveland Clinic, USA.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Cohen
authors.affiliation: Department of Neurology and Neurotherapeutics, University of Texas Southwestern, USA.
authors.forename: Olaf
authors.initials: O
authors.lastname: Stuve
authors.affiliation: Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari, Italy.
authors.forename: Maria
authors.initials: M
authors.lastname: Trojano
authors.affiliation: Department of Biostatistics, University of Alabama at Birmingham, USA.
authors.forename: Gary
authors.initials: G
authors.lastname: Cutter
authors.affiliation: Scientific and Clinical Review Associates, LLC, USA.
authors.forename: Stephen
authors.initials: S
authors.lastname: Reingold
authors.affiliation: Department of Neurology, Copenhagen University Hospital Rigshospitalet, Denmark.
authors.forename: Per Soelberg
authors.initials: PS
authors.lastname: Sorensen
mesh_terms: D002561:Cerebrovascular Disorders / Q000453:epidemiology*; D015897:Comorbidity; D006331:Heart Diseases / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D009103:Multiple Sclerosis / Q000453:epidemiology*; D016491:Peripheral Vascular Diseases / Q000453:epidemiology*; D015995:Prevalence
keywords: Multiple sclerosis; cardiac; comorbidity; incidence; peripheral vascular disease; prevalence; stroke; systematic review