{"id":{"repo_id":"buffalo","oai_identifier":"oai:ubir.buffalo.edu:10477/86451"},"canonical_url":"https://search.dev.ndltd.org/etd/buffalo/oai:ubir.buffalo.edu:10477/86451","repository":{"repo_id":"buffalo","name":"Buffalo","base_url":"https://ubir.buffalo.edu/oai/request"},"display":{"title":"The Effect of Cardiovascular Health on Multiple Sclerosis Disease Outcomes","abstract":"Ph.D.","abstract_html":"Ph.D.","abstract_has_math":false,"creators":["Jakimovski, Dejan; 0000-0001-7114-4958"],"institution":"State University of New York at Buffalo","degree_name":null,"degree_level":null,"degree_discipline":null,"degree_department":null,"school":null,"contributors":["Zivadinov, Robert","Neuroscience"],"advisors":[],"committee_chairs":[],"committee_members":[],"year":2025,"date_issued":"2025-02-21T17:22:34Z","date_published":"2025-02-21T17:22:34Z","updated_at":"2026-07-27T19:05:32Z","subjects":["neurosciences"],"languages":["eng"],"rights":["Users of works found in University at Buffalo Institutional Repository (UBIR) are responsible for identifying and contacting the copyright owner for permission to reuse. University at Buffalo Libraries do not manage rights for copyright-protected works and cannot assist with permissions.","Copyright retained by author."],"rights_urls":[],"identifier_entries":[]},"links":{"outbound_url":"http://hdl.handle.net/10477/86451","outbound_label":"Handle","outbound_source":"dc:identifier"},"metadata_groups":[{"id":"people","label":"People","entries":[{"key":"dc:contributor","label":"Contributor","values":["Zivadinov, Robert","Neuroscience"]},{"key":"dc:creator","label":"Author","values":["Jakimovski, Dejan; 0000-0001-7114-4958"]}]},{"id":"academic_context","label":"Academic Context","entries":[{"key":"dc:date","label":"Dc Date","values":["2025-02-21T17:22:34Z","2020"]},{"key":"dc:publisher","label":"Institution","values":["State University of New York at Buffalo"]},{"key":"dc:type","label":"Dc Type","values":["Text","Dissertation"]}]},{"id":"subjects_keywords","label":"Subjects and Keywords","entries":[{"key":"dc:subject","label":"Dc Subject","values":["neurosciences"]}]},{"id":"language_rights","label":"Language and Rights","entries":[{"key":"dc:language","label":"Dc Language","values":["eng"]},{"key":"dc:rights","label":"Dc Rights","values":["Users of works found in University at Buffalo Institutional Repository (UBIR) are responsible for identifying and contacting the copyright owner for permission to reuse. University at Buffalo Libraries do not manage rights for copyright-protected works and cannot assist with permissions.","Copyright retained by author."]}]},{"id":"identifiers","label":"Identifiers","entries":[{"key":"dc:identifier","label":"Identifier","values":["http://hdl.handle.net/10477/86451"]}]},{"id":"additional","label":"Additional Metadata","entries":[{"key":"dc:description","label":"Description","values":["Ph.D.","Due to increasingly improved long-term disease outcomes of the multiple sclerosis (MS) population, new questions regarding healthy aging and cardiovascular comorbidities emerge. Furthermore, epidemiological data suggests that MS patients are at a greater risk for developing cardiovascular disease (CVD). Currently there is a substantial lack of cross-sectional and longitudinal studies that investigate the effect of CVDs and lipid dyshomeostasis on the clinical and MRI-derived MS outcomes. This Ph.D. work aims at demonstrating and quantifying the effect of CVDs and cardiovascular-based behavior on MRI-derived measures of brain atrophy and lesion accrual in a heterogeneous population of MS patients. Moreover, it aims at determining the state of the extracranial vascular anatomy and function of MS patients in relation to the MS disability and cognition. Lastly, perfusion-weighted imaging (PWI) was utilized to understand the relationship between cardiovascular-based health and intracranial circulation. Total of 194 MS patients and 43 age-matched healthy controls (HCs) underwent 3T MRI imaging at both baseline and approximately 5-years follow-up visits. Specific sequences included high-resolution 3D-T1 weighted imaging (WI), fluid-attenuated inverse recovery (FLAIR), magnetic resonance angiography (MRA), and dynamic susceptibility contrast (DSC) PWI. Quantitative measures of brain volumes, brain atrophy and lesion accrual were calculated. The MS cohort was characterized using MS-based clinical scores like Expanded Disability Status Scale (EDSS), Multiple Sclerosis Severity Score (MSSS) and with the Brief International Cognitive Assessment for MS (BICAMS) battery. Serum samples were utilized for determining the respective lipid profile measures. Data regarding the cardiovascular diseases was collected and calculation of cardiovascular-based score of Healthy Heart Score (HHS) and the Framingham Coronary Heart Disease Risk Score were performed. For statistical analysis, a set of parametric and non-parametric comparative methods, correlation analyses, and linear regression models were utilized. The sample utilized for each analysis varied based on available data.MS patients with diagnosis of hypertension and heart disease had accelerated rate of central and whole brain atrophy. Furthermore, lifestyle-based behavior contributing towards CVDs was associated with greater central rain atrophy. Poorer dietary habits were also associated with greater longitudinal T2 lesion accrual. MS patients also presented with significantly narrower major extracranial vessels and lower amount of secondary collaterals when compared to age-, sex- and body mass index (BMI)-matched HCs. The MS patients also demonstrated significant narrowing of the arterial vessels and concurrent loss of the number and size of secondary vessels. Both age and levels of lipoprotein (a) may be important factors that affect the extracranial arterial lumen. The overall arterial blood flow was further associated with poorer cognitive performance in the MS population. Similarly, poorer intracranial perfusion measures were associated with poorer cognitive and physical performance in MS patients. The rate of cerebral perfusion measured as mean transit time was associated with greater levels of high-density lipoprotein (HDL) cholesterol and HDL-associated apolipoproteins. In conclusion, the cardiovascular health represents a significant modulator of the physical and neurological outcomes in MS patients. Future studies should determine the benefit of aggressive cardiovascular disease management in providing better long-term MS disease outcomes.","**To request an accessible version of the file(s) associated with this item, contact library@buffalo.edu. Please include the item's persistent URL [http://hdl.handle.net/. . .] in your request.**"]},{"key":"dc:format","label":"Dc Format","values":["application/pdf"]},{"key":"dc:title","label":"Title","values":["The Effect of Cardiovascular Health on Multiple Sclerosis Disease Outcomes"]}]}],"canonical_facts":{"dc:contributor":["Zivadinov, Robert","Neuroscience"],"dc:creator":["Jakimovski, Dejan; 0000-0001-7114-4958"],"dc:date":["2025-02-21T17:22:34Z","2020"],"dc:description":["Ph.D.","Due to increasingly improved long-term disease outcomes of the multiple sclerosis (MS) population, new questions regarding healthy aging and cardiovascular comorbidities emerge. Furthermore, epidemiological data suggests that MS patients are at a greater risk for developing cardiovascular disease (CVD). Currently there is a substantial lack of cross-sectional and longitudinal studies that investigate the effect of CVDs and lipid dyshomeostasis on the clinical and MRI-derived MS outcomes. This Ph.D. work aims at demonstrating and quantifying the effect of CVDs and cardiovascular-based behavior on MRI-derived measures of brain atrophy and lesion accrual in a heterogeneous population of MS patients. Moreover, it aims at determining the state of the extracranial vascular anatomy and function of MS patients in relation to the MS disability and cognition. Lastly, perfusion-weighted imaging (PWI) was utilized to understand the relationship between cardiovascular-based health and intracranial circulation. Total of 194 MS patients and 43 age-matched healthy controls (HCs) underwent 3T MRI imaging at both baseline and approximately 5-years follow-up visits. Specific sequences included high-resolution 3D-T1 weighted imaging (WI), fluid-attenuated inverse recovery (FLAIR), magnetic resonance angiography (MRA), and dynamic susceptibility contrast (DSC) PWI. Quantitative measures of brain volumes, brain atrophy and lesion accrual were calculated. The MS cohort was characterized using MS-based clinical scores like Expanded Disability Status Scale (EDSS), Multiple Sclerosis Severity Score (MSSS) and with the Brief International Cognitive Assessment for MS (BICAMS) battery. Serum samples were utilized for determining the respective lipid profile measures. Data regarding the cardiovascular diseases was collected and calculation of cardiovascular-based score of Healthy Heart Score (HHS) and the Framingham Coronary Heart Disease Risk Score were performed. For statistical analysis, a set of parametric and non-parametric comparative methods, correlation analyses, and linear regression models were utilized. The sample utilized for each analysis varied based on available data.MS patients with diagnosis of hypertension and heart disease had accelerated rate of central and whole brain atrophy. Furthermore, lifestyle-based behavior contributing towards CVDs was associated with greater central rain atrophy. Poorer dietary habits were also associated with greater longitudinal T2 lesion accrual. MS patients also presented with significantly narrower major extracranial vessels and lower amount of secondary collaterals when compared to age-, sex- and body mass index (BMI)-matched HCs. The MS patients also demonstrated significant narrowing of the arterial vessels and concurrent loss of the number and size of secondary vessels. Both age and levels of lipoprotein (a) may be important factors that affect the extracranial arterial lumen. The overall arterial blood flow was further associated with poorer cognitive performance in the MS population. Similarly, poorer intracranial perfusion measures were associated with poorer cognitive and physical performance in MS patients. The rate of cerebral perfusion measured as mean transit time was associated with greater levels of high-density lipoprotein (HDL) cholesterol and HDL-associated apolipoproteins. In conclusion, the cardiovascular health represents a significant modulator of the physical and neurological outcomes in MS patients. Future studies should determine the benefit of aggressive cardiovascular disease management in providing better long-term MS disease outcomes.","**To request an accessible version of the file(s) associated with this item, contact library@buffalo.edu. Please include the item's persistent URL [http://hdl.handle.net/. . .] in your request.**"],"dc:format":["application/pdf"],"dc:identifier":["http://hdl.handle.net/10477/86451"],"dc:language":["eng"],"dc:publisher":["State University of New York at Buffalo"],"dc:rights":["Users of works found in University at Buffalo Institutional Repository (UBIR) are responsible for identifying and contacting the copyright owner for permission to reuse. University at Buffalo Libraries do not manage rights for copyright-protected works and cannot assist with permissions.","Copyright retained by author."],"dc:subject":["neurosciences"],"dc:title":["The Effect of Cardiovascular Health on Multiple Sclerosis Disease Outcomes"],"dc:type":["Text","Dissertation"]},"updated_at":"2026-07-27T19:05:32Z"}