MD Doctor of Medicine

High-density lipoprotein cholesterol in multiple sclerosis: A systematic review and meta-analysis (Under the supervision of Dr. Aris Dimitrios Angouridis; Steering Committee member A: Dr. D. Papadopoulos; Steering Committee member B: Dr. C. Tsioutis) Introduction: Multiple sclerosis (MS) is a chronic inflammatory disease of the central nervous system (CNS) and leads to demyelination and axonal degeneration. Evidence showed that lipid metabolism is associated with adverse clinical outcomes in MS. Purpose: To systematically investigate all relevant evidence on the association between high-density lipoprotein cholesterol (HDL-C) and clinical parameters of disease activity in MS. Methodology: The PubMed and Cochrane library databases were searched for studies with data on HDL-C in patients with MS. A qualitative synthesis of published prospective and retrospective studies for the role of HDL-C and other lipid profile parameters in MS was performed. Additionally, a meta-analysis on HDL-C mean differences (MD) between Relapsing Remitting Multiple Sclerosis (RRMS) cases and healthy controls (HC) was performed. Results: Literature search identified 13 potentially eligible trials evaluating the HDL-C of RRMS patients. In total, they included 1652 participants, 819 of which were RRMS patients, and 833 were HC. The pooled analysis demonstrated that RRMS patients had significantly lower HDL-C levels compared with the HC group (MD: -2.99 mg/dl, 95% CI: -5.19, -0.79, p = 0.008). Subgroup analysis did not reveal a significant HDLC concentration difference between RRMS and progressive MS patients (PMS) (MD: 0.34 mg/dl, 95%CI: [-2.66, 3.34], p = 0.82). Regarding triglycerides, pooled analysis from 11 studies (534 RRMS and 589 HC patients) showed significantly higher triglyceride levels in RRMS compared with HC (MD: 22.99 mg/dl, 95% CI: 14.14, 31.83, p < 0.00001). Conclusion: According to our results, low levels of HDL-C represent a potential biomarker of disease activity in MS. Future research opportunities in MS include investigating the role of lipids as potential indicators of disease burden and treatment response biomarkers.