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Health See other Health Articles Title: Smoking Linked to Increased MS Mortality October 12, 2012 (Lyon, France) — Smoking increases all-cause mortality risk in patients with multiple sclerosis (MS), a new study shows. Further, the researchers found smoking increased the social and economic costs associated with this increased mortality. On the basis of their findings, "we came to the conclusion that in our cohort, smoking was associated with a significantly higher risk of death," lead author Ali Manouchehrinia, MD, from the University of Nottingham, United Kingdom, told delegates here. "And we believe that in addition to MS, there are modifiable risk factors which decrease patients' life span, and they need to be taken into account." Results were presented here at the 28th Congress of the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS). Smoking Effects in MS It's well known that patients with MS have increased mortality compared with the general population, Dr. Manouchehrinia noted. "We have a population of patients who have a disease, in fact a very disabling disease, but it doesn't necessarily mean they have to die at a younger age," he said. "We believe there are risk factors that contribute to this number, and if we can identify them, we may be able to actually improve this number." It's also known that smoking affects the disease process in MS, he added; there is a higher risk for transition to secondary progressive MS, increased accumulation of disability over a shorter time, as well as higher lesion loads on magnetic resonance imaging and more brain atrophy. Data on the effect of smoking on mortality are limited, so that was the aim of this study. Dr. Manouchehrinia and colleagues used data on clinical and demographic characteristics of 895 individuals, obtained from a large population-based cohort of patients with MS. Records were linked to the National Health Service death data up to December 2011. Patients were followed from the onset age to the death age or the index date of December 2011, whichever came first. The effects on mortality risk of sex, disease clinical course at the time of onset, onset age, 1-year or longer exposure to disease-modifying treatment, and smoking status (ever or never) at the time of onset were investigated by using Cox proportional hazard regression model. Of 895 patients, 66 were deceased at the index date, and 45 of these were ever-smokers. The mean age at the time of death was 65 years. Women made up 42% of those who died vs 72% of those still alive at the end of the study period. All of the patients with relapsing-remitting MS who died in this group were ever-smokers, compared with 50% of those with primary progressive MS and almost 70% of those with secondary progressive disease. The mortality rates were 5.4778 (95% confidence interval [CI], 4.0899 - 7.336) per 1000 person-years among ever-smokers and 2.2.2958 (95% CI, 1.4969 - 3.5212) for never-smokers. Smokers were at higher risk for death, with a hazard ratio of 2.13 (95% CI, 1.26 - 3.61; P = .005) relative to never-smokers. The investigators also looked at the social and economic costs of this differential mortality. In this group alone, they calculated that the loss of potential life-years totaled 1779 years for 66 premature deaths and provided an excess cost to society of about $14 million, based on the estimated value of a typical life of $7.9 million put forward by the US Food and Drug Administration, Dr. Manouchehrinia said. During the discussion period, Dr. Manouchehrinia was asked about what was known in this population about competing causes of death, such as cardiovascular disease and lung cancer, other known risks of smoking. "We didn't have this kind of data, but we're working on it, to actually see if the morbidity that arises from smoking can explain this," he said. A second report from this group using this same cohort showed that patients with MS were more likely to have been smokers, and that ever-smoking was associated with more rapid progression of disease. More Reason Not to Smoke George Ebers, MD, from the Division of Clinical Neurology, Nuffield Department of Clinical Neurosciences at the University of Oxford, United Kingdom, who acted as moderator for the session, did not find the results surprising. "Of all the many, many reasons not to smoke, this is another one," he told Medscape Medical News. He was uncertain, though, whether the case had been entirely made at this point for an interaction between smoking and increased mortality, particularly among patients with MS, that is not explained by the known risks of smoking. Lily K. Jung Henson, MD, from the Swedish Neuroscience Institute and medical director at Eastside Neurology Services, Seattle, Washington, called the findings "exciting," suggesting that "cessation of smoking can reduce the mortality associated with MS on top of what we already know about it causing people with [clinically isolated syndrome] to develop clinically definite MS, to have more attacks and also develop progression into secondary progressive MS, so it's a very treatable, manageable thing that people can do actively to help themselves," she told Medscape Medical News. Even without putting cardiovascular disease or lung cancer into the equation, she added, "the idea that you could have worsening of your MS and therefore shorten your lifespan, by itself, is pretty darn relevant, I think." The study received no specific funding support. The authors, Dr. Ebers, and Dr. Jung Henson have disclosed no relevant financial relationships. 28th Congress of the European Committee for Treatment and Research in Multiple Sclerosis. Abstract 65, P375. Presented October 11, 2012. Poster Comment: Also see: http://www.medscape.com/viewarticle/772551 Post Comment Private Reply Ignore Thread
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