The Heart-Brain Interplay in Multiple Sclerosis from Pathophysiology to Clinical Practice: A Narrative Review

Multiple sclerosis (MS) is a chronic neurological disorder characterized by inflammation in the central nervous system (CNS) that leads to neurodegeneration. The clinical course is highly variable, but its prevalence is rising worldwide, partly thanks to novel disease-modifying therapies. Additionally, the lifespan of people with MS is increasing, and for this reason, it is fundamental to have a multidisciplinary approach to MS. MS may be associated with cardiovascular diseases (CVD), but there is scarce attention on this issue. In particular, CNS is essential in regulating the autonomic system and heart activity. Moreover, cardiovascular risk factors show a higher prevalence in MS patients. On the other hand, conditions like Takotsubo syndrome are rare complications of MS. The parallelism between MS and myocarditis is also interesting. Finally, cardiac toxicity represents a not infrequent adverse reaction to MS drugs. This narrative review aims to provide an overview of cardiovascular complications in MS and their management to prompt further clinical and pre-clinical research on this topic.

Automated summary

Multiple sclerosis (MS) is a chronic neurological disorder characterized by CNS inflammation leading to neurodegeneration. The prevalence of MS is increasing globally, partly due to novel therapies. A multidisciplinary approach is essential for managing MS, considering its association with cardiovascular diseases and the higher prevalence of cardiovascular risk factors in MS patients. Rare complications such as Takotsubo syndrome and parallels with myocarditis are also observed. Cardiac toxicity is a common adverse reaction to MS drugs. This narrative review aims to provide an overview of cardiovascular complications in MS and their management, advocating for further research in this field.