Dr. Cooke was very kind in responding to me, and said that the research I had compiled appeared to point to an association, but that the MS specialists he talked to at his university asserted the autoimmune nature of the disease, and the lack of connection between the heart and brain health in MS. At that time, not many researchers considered endothelial dysfunction a component on MS disease progression. Endothelial dysfunction was a known contributor to heart disease and stroke, however researchers weren't really looking at it in terms of diseases of neurodegeneration.
In fact, when I wrote about the endothelium, most lay people and even some medical people I spoke to had never encountered the word, but thankfully, this is changing. The endothelium is the largest secreting organ in the human body. It is the layer of cells which line the 60,000 miles of blood vessels that nourish our bodies. When endothelial cells are damaged and die, we see markers of this in the blood. Endothelial health is essential to the health of the body's organs and tissues. The heart and brain included.
Today, more and more MS researchers are considering this connection.
There is about 30% higher risk of the myocardial infarction in patients diagnosed with multiple sclerosis (MS) than in people without MS. Increased risk of cardiovascular disease development positively correlates with levels of serum markers of an endothelial dysfunction, and may give rise to a global cerebral hypoperfusion. It appears that these complications precede progressive loss of axons, which mechanisms are complex and should be linked to a loss of β2 adrenergic receptors on astrocytes of demyelinating lesions. Consequence of this deficiency, the cause of which is not known yet, is a decline in energy metabolism of axons. Moreover, the loss of these receptors is linked to a reduced redistribution of potassium ions by astrocytes, glutamate excitotoxicity and increase of calcium ion concentration in the axon with subsequent activation of necrotic processes. In addition to immunological aspects we should take into account also parameters of the functional state of endothelium when appropriate targeted therapy for patient is considered. http://www.ncbi.nlm.nih.gov/pubmed/25702293
Patients with MS showed increased frequency of smoking (51.7% vs 36.5%, p=0.001) and hypertension (33.9% vs 24.7%, p=0.035) compared with HCs. In total, 49.9% of patients with MS and 36% of HCs showed ≥2 CV risks (p=0.003), while the frequency of ≥3 CV risks was 18.8% in the MS group and 8.6% in the HCs group (p=0.002). In patients with MS, hypertension and heart disease were associated with decreased grey matter (GM) and cortical volumes (p<0.05), while overweight/obesity was associated with increased T1-LV (p<0.39) and smoking with decreased whole brain volume (p=0.049). Increased lateral ventricle volume was associated with heart disease (p=0.029) in CIS.
Patients with MS with one or more CV risks showed increased lesion burden and more advanced brain atrophy.