{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T22:33:51Z","timestamp":1790980431922,"version":"4.1.0"},"reference-count":32,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2026,2,9]],"date-time":"2026-02-09T00:00:00Z","timestamp":1770595200000},"content-version":"vor","delay-in-days":8,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,2,1]],"date-time":"2026-02-01T00:00:00Z","timestamp":1769904000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100001922","name":"Efficacy and Mechanism Evaluation Programme","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001922","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Euro J of Neurology"],"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Vascular risk factors are associated with increased disease activity and disability progression in multiple sclerosis (MS). This has been studied mainly in cohorts with relapsing\u2013remitting MS. However, the association between vascular comorbidities (VCM) and clinical disability in secondary progressive MS (SPMS) is less well studied. Our aim was to investigate the association between VCM, non\u2010VCM, comorbidity burden and both physical and cognitive performance in SPMS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Longitudinal analysis of 445 patients from the MS secondary progressive multi\u2010arm trial (MS\u2010SMART)\u2013a multi\u2010arm multicentre phase\u20102b randomised placebo\u2010controlled trial of three agents in SPMS (NCT01910259). VCM (hypertension and hyperlipidaemia) and non\u2010VCM (asthma, hypothyroidism and osteoporosis) were recorded. A comorbidity score was also determined (0, 1, \u2265\u20092). Physical disability and processing speed were assessed at baseline, 48\u2010 and 96\u2009weeks. Multiple linear regression and mixed models were used to investigate the cross\u2010sectional and longitudinal relationships between baseline VCM, non\u2010VCM, comorbidity score and clinical outcome measures.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The cohort was predominantly female (67%), median Expanded Disability Status Scale (EDSS) 6.0. 13% and 9% had hypertension and hyperlipidaemia (VCM), respectively. 7%, 9% and 5% had asthma, hypothyroidism and osteoporosis (non\u2010VCM), respectively. Co\u2010morbidity counts were 0,63%; 1, 23% and with &gt;\u2009=\u20092, 11%. In cross\u2010sectional models, both hypertension (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u2009=\u20090.36, 95% CI 0.18\u20130.54) and an increased comorbidity count (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u2009=\u20090.47, 95% CI 0.28\u20130.67) were associated with higher EDSS scores. In longitudinal models, hyperlipidaemia (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u2009=\u20090.22, 95% CI 0.02\u20130.42) and increased comorbidity count (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u2009=\u20090.21, 95% CI 0.01\u20130.41) were associated with increased EDSS scores over 48\/96\u2009weeks. No associations were seen with the non\u2010VCM.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>VCM and also increased comorbidity burden per se are associated with increased disability. Disability worsening over 96\u2009weeks was most evident in those with hyperlipidaemia and increased comorbidity burden.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/ene.70517","type":"journal-article","created":{"date-parts":[[2026,2,10]],"date-time":"2026-02-10T05:50:41Z","timestamp":1770702641000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Vascular Comorbidities and an Increased Comorbidity Score Are Associated With Disability and Disability Progression in Secondary Progressive Multiple Sclerosis"],"prefix":"10.1111","volume":"33","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9834-4498","authenticated-orcid":false,"given":"Nevin A.","family":"John","sequence":"first","affiliation":[{"name":"Department of Medicine School of Clinical Sciences, Monash University  Clayton Victoria Australia"},{"name":"Department of Neurology Monash Health  Melbourne Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yingtong","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Medicine School of Clinical Sciences, Monash University  Clayton Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Floriana De","family":"Angelis","sequence":"additional","affiliation":[{"name":"Department of Neuroinflammation, Queen Square Multiple Sclerosis Centre UCL Institute of Neurology, Faculty of Brain Sciences, University College London  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ferran Prados","family":"Carrasco","sequence":"additional","affiliation":[{"name":"Department of Neuroinflammation, Queen Square Multiple Sclerosis Centre UCL Institute of Neurology, Faculty of Brain Sciences, University College London  London UK"},{"name":"Centre for Medical Image Computing (CMIC), University College London  London UK"},{"name":"e\u2010Health Center, Universitat Oberta de Catalunya  Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jon","family":"Stutters","sequence":"additional","affiliation":[{"name":"Department of Neuroinflammation, Queen Square Multiple Sclerosis Centre UCL Institute of Neurology, Faculty of Brain Sciences, University College London  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anisha","family":"Doshi","sequence":"additional","affiliation":[{"name":"Department of Neuroinflammation, Queen Square Multiple Sclerosis Centre UCL Institute of Neurology, Faculty of Brain Sciences, University College London  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alberto","family":"Calvi","sequence":"additional","affiliation":[{"name":"Laboratory of Advanced Imaging in Neuroimmunological Diseases (imaginEM), Fundaci\u00f3 de Recerca Cl\u00ednic Barcelona \u2013 Institut d'Investigacions Biom\u00e8diques August Pi I Sunyer (FRCB\u2010IDIBAPS)  Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Domenico","family":"Plantone","sequence":"additional","affiliation":[{"name":"Department of Medicine, Surgery &amp; Neuroscience University of Siena  Siena Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Williams","sequence":"additional","affiliation":[{"name":"Department of Neuroinflammation, Queen Square Multiple Sclerosis Centre UCL Institute of Neurology, Faculty of Brain Sciences, University College London  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thanh","family":"Phan","sequence":"additional","affiliation":[{"name":"Department of Medicine School of Clinical Sciences, Monash University  Clayton Victoria Australia"},{"name":"Department of Neurology Monash Health  Melbourne Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeremy","family":"Chataway","sequence":"additional","affiliation":[{"name":"Department of Neuroinflammation, Queen Square Multiple Sclerosis Centre UCL Institute of Neurology, Faculty of Brain Sciences, University College London  London UK"},{"name":"National Institute for Health Research (NIHR), University College London Hospitals (UCLH) Biomedical Research Centre (BRC)  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"for the MS\u2010SMART Investigators","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,2,9]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/ene.12720"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2020.00851"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2023.1197195"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.msard.2020.102593"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000010024"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1212\/CPJ.0000000000000838"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000004716"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1177\/1352458516650512"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000001187"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600\u20100404.2011.01526.x"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0b013e3181d6b125"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1212\/01.wnl.0000333252.78173.5f"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen\u20102018\u2010021944"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1474\u20104422(19)30485\u20105"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1111\/ene.16586"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.33.11.1444"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1177\/1352458517690823"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.1177\/1352458517690824"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1177\/1352458517690821"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.1006\/NIMG.2002.1040"},{"key":"e_1_2_10_22_1","doi-asserted-by":"publisher","DOI":"10.1080\/00029890.1962.11989827"},{"key":"e_1_2_10_23_1","volume-title":"R: A Language and Environment for Statistical Computing","author":"R Core Team","year":"2021"},{"key":"e_1_2_10_24_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000209135"},{"key":"e_1_2_10_25_1","article-title":"Prognostic Factors in Multiple Sclerosis","author":"Espiritu A. 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