Meta-Analysis Reveals Significant Burden of Cardiovascular Comorbidities in Myasthenia Gravis

A new meta-analysis presented at the 2024 American Association of Neuromuscular & Electrodiagnostic Medicine (AANEM) meeting, held October 15-18, in Savannah, Georgia, highlighted the significant burden of cardiovascular comorbidities in patients with myasthenia gravis (MG). All told, the data reinforced the importance of comprehensive cardiovascular risk assessment and management among this patient population, calling for interventions that target cardiovascular outcomes in MG.¹

In the analysis, the prevalence rates of cardiovascular conditions in patients with MG varied across 12 observational studies (patients, n = 7218). The pooled prevalence estimates were as follows: cerebrovascular diseases at 21%, based on data from 3104 patients (95% CI, 14%-29%); hypertension at 21%, based on data from 2537 patients (95% CI, 11%-35%); coronary artery disease at 8%, based on data from 538 patients (95% CI, 3%-19%); congestive heart failure at 2%, based on data from 3693 patients (95% CI, 1%-4%); and myocardial infarction at 5%, based on data from 3344 patients (95% CI, 2%-9%).

The study, conducted by senior author Sarosh Ahmed, PT, DPT, CBIS-T, a physical therapist at TIRR Memorial Hermann Hospital in Houston, Texas, and colleagues, aimed to provide a comprehensive risk profile overview of cardiovascular comorbidities in patients with MG. Investigators searched PubMed, Scopus, and Web of Science databases for current evidence from primary studies through March 2024, and extracted prevalence rates and corresponding sample sizes from eligible studies. Researchers performed the meta-analysis to estimate pooled prevalence rates for cardiovascular comorbidities including coronary artery disease, congestive heart failure, cerebrovascular diseases, hypertension, and myocardial infarction using the 'meta' package in R version 4.4.3.

Prior studies have shown that MG, a chronic autoimmune neuromuscular disorder, is typically characterized by varying degrees of skeletal muscle weakness. Although the disease primarily manifests through ocular and generalized muscle weakness, its effect can extend beyond these symptoms in patients, impacting both the quality of life and morbidity spectrum such as cardiovascular diseases. Another recent study, published in World Journal of Clinical Cases, demonstrated that cardiac involvement in MG was often associated with thymoma, anti-Kv 1.4 antibodies, and advancing age.² Thus, these findings suggest that clinicians should consider the assessment of autonomic dysfunction and risk of cardiovascular disease in patients with MG.

REFERENCES
1. Tahir S, Iguh C, Sadik O, et al. Cardiovascular Comorbidities And Myasthenia Gravis: A Systematic Review And Meta-Analysis. Presented at: 2024 AANEM; October 15-18; Savannah, Georgia. Abstract 281.
2. Nag DS, Chatterjee A, Mahanty PR, Sam M, Bharadwaj MK. Perioperative cardiac risks in myasthenia gravis. World J Clin Cases. 2024;12(13):2147-2150. doi:10.12998/wjcc.v12.i13.2147