{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T23:40:20Z","timestamp":1777938020631,"version":"3.51.4"},"reference-count":25,"publisher":"SAGE Publications","issue":"5","license":[{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/100005614","name":"Biogen","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100005614","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Mult Scler"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Fatigue is common in multiple sclerosis and may be influenced by cardiovascular comorbidities.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective:<\/jats:title>\n                    <jats:p>To test whether cardiovascular comorbidity burden relates to fatigue at baseline and over time, and to assess dose response.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>\n                      We analyzed prospectively collected data from MS PATHS across 10 centers. Fatigue was measured with Neuro-QoL Fatigue\n                      <jats:italic toggle=\"yes\">T<\/jats:italic>\n                      -scores. Cardiovascular comorbidity was defined as a composite (any vs none) and as a count of hypertension, diabetes, and dyslipidemia. Cross-sectional associations and longitudinal trajectories were modeled using multivariable regression. Extended models also included depression, anxiety, and sleep disturbance.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Among 5507 participants, 49% had no cardiovascular comorbidity, 32% had one, 16% had two, and 3% had three. In minimally adjusted cross\u2011sectional models, any comorbidity was associated with higher fatigue (beta\u202f=\u202f0.85; 95%\u202fCI, 0.18 to 1.53), with attenuation after adjustment for depression, anxiety, and sleep (beta\u202f=\u202f0.20; 95% CI, \u22120.09 to 0.49). A graded dose response was evident across 0\u20133 conditions. In longitudinal analyses, effect sizes were larger and remained positive after adjustment (Any vs None: beta\u2009=\u20091.06 in minimal models; beta\u2009=\u20090.39 after adjustment), consistent with a greater comorbidity burden associated with higher fatigue over time.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Cardiovascular comorbidity burden is associated with greater fatigue, with a dose response over time.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/13524585261438014","type":"journal-article","created":{"date-parts":[[2026,4,5]],"date-time":"2026-04-05T16:04:37Z","timestamp":1775405077000},"page":"539-547","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Cardiovascular comorbidities are associated with cross-sectional and longitudinal measures of multiple sclerosis fatigue"],"prefix":"10.1177","volume":"32","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0890-8852","authenticated-orcid":false,"given":"Mahsa","family":"Ghajarzadeh","sequence":"first","affiliation":[{"name":"The Johns Hopkins University School of Medicine, Baltimore, MD, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ellen M","family":"Mowry","sequence":"additional","affiliation":[{"name":"The Johns Hopkins University School of Medicine, Baltimore, MD, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3137-0322","authenticated-orcid":false,"given":"Kathryn C","family":"Fitzgerald","sequence":"additional","affiliation":[{"name":"The Johns Hopkins University School of Medicine, Baltimore, MD, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6617-2003","authenticated-orcid":false,"given":"Bardia","family":"Nourbakhsh","sequence":"additional","affiliation":[{"name":"The Johns Hopkins University School of Medicine, Baltimore, MD, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2026,4,5]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1093\/sleep\/33.8.1061"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12883-021-02396-1"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2024.1457788"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1007\/978-3-031-13498-2"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jns.2017.01.002"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1177\/1352458520984746"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamaneurol.2024.2920"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1111\/ene.14162"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1007\/s12325-019-00958-x"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2020.00632"},{"key":"e_1_3_2_12_2","article-title":"Neuro-QOL: Brief measures of health-related quality of life for clinical research in neurology","volume":"93","author":"Cella D","year":"2012","unstructured":"Cella D, Nowinski C, Peterman A, et al. Neuro-QOL: Brief measures of health-related quality of life for clinical research in neurology. Arch Phys Med Rehabil 2012; 93: S49\u2013S60.","journal-title":"Arch Phys Med Rehabil"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1177\/1352458515599450"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2377-13-37"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.7224\/1537-2073.2021-102"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2017.11.005"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1080\/00273171.2011.568786"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.7224\/1537-2073.2015-070"},{"key":"e_1_3_2_19_2","first-page":"10941","article-title":"Cardiovascular dysfunction in multiple sclerosis: A systematic review of pathophysiology and clinical implications","volume":"2015","author":"Mincu RI","year":"2015","unstructured":"Mincu RI, Cinteza M, Mitu F, et al. Cardiovascular dysfunction in multiple sclerosis: A systematic review of pathophysiology and clinical implications. Biomed Res Int 2015; 2015: 10941.","journal-title":"Biomed Res Int"},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2020.00851"},{"key":"e_1_3_2_21_2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000004885"},{"key":"e_1_3_2_22_2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0b013e3181d6b125"},{"key":"e_1_3_2_23_2","doi-asserted-by":"publisher","DOI":"10.1111\/ene.16586"},{"key":"e_1_3_2_24_2","doi-asserted-by":"crossref","unstructured":"Marrie RA Patel R Figley CR et al. Effects of vascular comorbidity on cognition in multiple sclerosis are partially mediated by changes in brain structure. Front Neurol 2022; 13: 910014 https:\/\/www.frontiersin.org\/article\/10.3389\/fneur.2022.910014 (accessed 10 June 2022).","DOI":"10.3389\/fneur.2022.910014"},{"issue":"15","key":"e_1_3_2_25_2","first-page":"3850","article-title":"The contributions of vascular comorbidities on self-reported functional issues in persons with multiple sclerosis","volume":"47","author":"Gromisch ES","year":"2025","unstructured":"Gromisch ES, Neto LO, Lo AC, et al. The contributions of vascular comorbidities on self-reported functional issues in persons with multiple sclerosis. 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