The majority of people with progressive multiple sclerosis (MS) continue to experience worsening disability despite current best available treatment. There is an urgent need to: a) identify additional factors which contribute to disability worsening; and b) develop treatments targeting these factors so we can reduce the risk of people getting worse.

There is some evidence that in people with progressive MS, cardiovascular risk factors (smoking, raised cholesterol, high blood pressure, diabetes, etc) may contribute to worsening disability. Such cardiovascular risk factors are easily treatable, but currently largely ignored in MS care. The treatment of cardiovascular risk factors may therefore represent an exciting opportunity, and relative “low hanging fruit”, in terms of helping people with progressive MS.

Before we can consider whether all people with progressive MS should have these cardiovascular risk factors tightly controlled, however, we need more evidence that such an approach would be beneficial.

In this project I will use detailed information from the MS-STAT2 randomised controlled trial (NCT03387670). This study includes almost 1000 people with secondary progressive MS, who were randomly allocated to high-dose simvastatin or placebo and closely monitored for up to 4.5 years. I will assess whether the presence of cardiovascular risk factors contributed to disease worsening by looking at changes on MRI scans, physical disability, and memory tests. Importantly, I will then assess whether simvastatin, a drug commonly used to treat cardiovascular risk, reduced the contribution of these factors to disease worsening.

If my results suggest that the contribution of cardiovascular risk factors to disability worsening can be lessened through simvastatin treatment, this will open the door to a range of novel treatment avenues for people with progressive MS – all targeting different aspects of cardiovascular risk.