MS vs. Atherosclerosis: What's the Difference — and Is There a Connection?

Multiple sclerosis (MS) and atherosclerosis are two conditions that confuse a lot of people — and understandably so. The names sound nearly identical; both involve inflammation and a process called sclerosis. But they affect entirely different parts of the body and have very different causes, symptoms, and treatments.

First, What Does “Sclerosis” Actually Mean?

The word sclerosis simply means a stiffening or hardening of tissue — it comes from the Greek skleros, meaning hard. So both conditions involve some form of hardening, but the tissue involved and the underlying cause are entirely different. Think of it like this: the word “fracture” applies to both a broken wrist and a fractured relationship. Same word, completely different reality.

In multiple sclerosis, the hardening refers to scar tissue that forms on nerve fibers in the brain and spinal cord. Atherosclerosis refers to the buildup of plaque inside the walls of arteries. Two distinct diseases, affecting two distinct organ systems, with very different causes, symptoms, and treatments.

What Is Multiple Sclerosis (MS)?

Multiple sclerosis is a chronic autoimmune disease of the central nervous system. According to a comprehensive 2024 review published in Medicine, MS involves “demyelination, inflammation, neuronal loss, and gliosis (scarring)” — meaning the immune system mistakenly attacks myelin, the protective sheath that wraps around nerve fibers and helps them conduct signals efficiently. When that sheath is damaged, signals traveling along the nerves slow down or stop entirely.

It’s estimated that around 2.8 million people worldwide are living with MS, and it disproportionately affects people assigned female at birth, who are about 2 to 3 times more likely than people assigned male at birth to develop the disease. It most commonly appears between the ages of 20 and 40.

Types of MS

Not all MS looks the same. The four main types are:

Relapsing-Remitting MS (RRMS) is the most common form, accounting for roughly 85% of initial diagnoses. People with RRMS experience episodes of new or worsening symptoms (relapses) followed by periods of partial or full recovery.

Secondary Progressive MS (SPMS) develops in many people who initially had RRMS. Over time, the disease transitions from relapsing to a more steady pattern of worsening.

Primary Progressive MS (PPMS) involves a gradual worsening from the start, without distinct relapses. It tends to affect the spinal cord more severely and accounts for about 10 to 15% of cases.

Progressive-Relapsing MS (PRMS) is the least common form, involving steady progression with occasional acute relapses.

MS Symptoms

Because MS can affect any area of the central nervous system, symptoms vary enormously from person to person and can change over time. Common symptoms include:

• Vision changes, including blurriness, double vision, or pain behind the eye
• Numbness or tingling in the limbs, face, or torso
• Fatigue, which is often profound and difficult to explain to others
• Muscle weakness, stiffness, or spasms
• Problems with balance and coordination
• Bladder and bowel dysfunction
• Cognitive difficulties, including memory and concentration problems
• Mood changes, including depression and anxiety

The unpredictability of MS — not knowing when a relapse will come or how the disease will progress — is one of the most challenging aspects people describe living with.

What Causes MS?

New studies reinforce the strong link between Epstein-Barr virus (EBV) and MS, and research continues to identify genetic factors that may influence disease progression. Environmental factors, including vitamin D levels, smoking, and geographic location (MS is more prevalent farther from the equator), also appear to play roles. But the precise trigger remains unknown.

MS Treatment

While there is no cure for MS, current treatments such as disease-modifying therapies (DMTs) and steroids focus on managing relapses and reducing long-term disability. The treatment landscape has expanded dramatically over the past two decades, and promising therapeutic developments, including Bruton Tyrosine Kinase (BTK) inhibitors and CAR T-cell therapies, are being actively studied. Managing symptoms — fatigue, pain, bladder issues, mood — is an equally important part of care.

What Is Atherosclerosis?

Atherosclerosis is a cardiovascular disease, not a neurological one. It involves the gradual buildup of plaque (a mixture of cholesterol, fats, calcium, and inflammatory cells) inside the walls of arteries. Over time, this buildup narrows the arteries, stiffens them, and restricts blood flow.

A 2024 review in the International Journal of Molecular Sciences describes atherosclerosis as the primary pathological process underlying most cardiovascular diseases and the leading cause of mortality worldwide. It’s widespread: heart attacks, strokes, and peripheral artery disease are all typically downstream consequences of atherosclerosis.

What Causes Atherosclerosis?

Atherosclerosis is driven by a complex interplay of lipid dysregulation, inflammation, and vascular pathology. The classic risk factors are well-established:

• High LDL (“bad”) cholesterol
• High blood pressure
• Smoking
• Type 2 diabetes
• Obesity
• Physical inactivity
• Family history

A 2025 review in Frontiers in Cardiovascular Medicine emphasizes that atherosclerosis is driven primarily by cumulative exposure to LDL cholesterol, which triggers inflammation in the arterial wall and sets off a cascade that leads to plaque formation over many years — often silently, with no symptoms until the disease is already well advanced.

Atherosclerosis Symptoms

The tricky thing about atherosclerosis is that it often causes no symptoms until it causes a crisis. Angina (chest pain), shortness of breath on exertion, or leg pain when walking may emerge as arteries narrow. But for many people, the first sign is a heart attack or stroke. This is why regular monitoring of cardiovascular risk factors matters — particularly cholesterol levels and blood pressure.

Atherosclerosis Treatment

Unlike MS, which has no cure but many treatments aimed at the immune system, atherosclerosis management focuses primarily on reducing risk factors and slowing plaque buildup. The cornerstone medications are statins, which lower LDL cholesterol. More recently, PCSK9 inhibitors have shown strong benefits for people at high cardiovascular risk. The same 2025 Frontiers in Cardiovascular Medicine review notes that intensive LDL cholesterol lowering has demonstrated real benefits in slowing and even partially reversing plaque progression.

Lifestyle changes — a heart-healthy diet, regular aerobic exercise, not smoking, and controlling blood pressure and blood sugar — remain the most powerful tools for prevention and management.

MS vs. Atherosclerosis: The Core Differences

To put it simply:

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Is There a Connection Between MS and Atherosclerosis?

The short answer is: There is a meaningful association between MS and increased cardiovascular risk, including atherosclerosis, though the research is still actively evolving. Having MS does not cause atherosclerosis, and atherosclerosis does not cause MS. But the two conditions are not completely unrelated either.

Shared inflammation — a key thread

Both MS and atherosclerosis are driven in part by chronic inflammation, just in different places in the body. In MS, the inflammatory process targets the central nervous system. In atherosclerosis, inflammation plays a central role in the pathophysiological evolution of atherosclerotic lesions. The immune system — overactive in MS — doesn’t confine its effects neatly to one organ.

A 2024 clinical review published in Multiple Sclerosis and Related Disorders noted that even after accounting for traditional cardiovascular risk factors like hypertension and high cholesterol, people with MS still face increased cardiovascular risk, “suggesting the presence of distinct underlying mechanisms.” In other words, something about MS itself — beyond its better-known risk factors — appears to raise cardiovascular risk.

What the research shows

A 2024 cross-sectional study published in PLOS ONE used carotid intima-media thickness (CIMT) — a well-validated ultrasound measure of early arterial wall thickening — to compare 114 people with MS against 127 healthy controls. The findings suggested a potential association between MS and increased cardiovascular risk, and called for further research to explore the underlying mechanisms.

A 2024 study published in Multiple Sclerosis and Related Disorders found a more cautious result: after careful analysis, MS was not independently associated with subclinical atherosclerosis as measured by CIMT in that specific sample — but it noted that the increased risk of ischemic heart disease in people with MS “is not accounted for by traditional vascular risk factors,” leaving the mechanism an open question.

What emerges from this body of research is not alarm but attentiveness. The picture is still being drawn, and the science is honest about its uncertainty. What’s clear is that cardiovascular health deserves active attention in people with MS — not as a source of dread, but as a reason for thoughtful, proactive care.

Why might MS raise cardiovascular risk?

Several mechanisms have been proposed. Physical inactivity is more common in people with MS due to fatigue, mobility challenges, and pain, and inactivity is a well-established cardiovascular risk factor. The chronic systemic inflammation of MS may also directly affect arterial walls. Some disease-modifying therapies used to treat MS may have effects on cholesterol and blood pressure. And depression, which is significantly more common in MS, is independently associated with cardiovascular risk.

As a 2025 review in Neurocardiology put it, “a complex interplay between genetic predisposition, traditional risk factors, autonomic dysfunction, inflammation, and treatment-related factors likely plays a role in promoting cardiovascular diseases in MS.”

What This Means for People Living With MS

If you have MS, the most important takeaway is this: cardiovascular health is part of your overall health picture, and it warrants the same attention you give to your neurological symptoms — but it is not something to catastrophize.

Practical steps that matter:

• Get your cholesterol and blood pressure checked regularly. These are modifiable risk factors, and knowing your numbers matters.
• Stay as physically active as your MS allows. Even gentle, adapted exercise has shown benefits for both neurological and cardiovascular health in MS. Talk with your care team about what’s appropriate for you.
• Don’t smoke, and if you do, pursue support to quit — smoking harms both MS disease activity and arterial health.
• Eat a heart-friendly diet, rich in vegetables, whole grains, and healthy fats. This is also broadly supportive of inflammation management.
• Manage depression and anxiety — not just for quality of life, but because mental health has real physical effects on cardiovascular risk.
• Talk openly with your neurologist and primary care provider about cardiovascular risk. These conversations sometimes fall through the cracks when MS management takes center stage.

A Note for Those With Health Anxiety

If you’re reading this because you have MS and you’re now worried you also have atherosclerosis — or because you have cardiovascular disease and you’re now wondering if something neurological is going on — please take a breath.

The relationship between MS and atherosclerosis is statistical, not deterministic. Having MS does not mean you will develop atherosclerosis. Having atherosclerosis does not mean you have or will develop MS. They are different diseases with different mechanisms and different trajectories.

The research we discussed above is exactly the kind that lives in nuance — associations, odds ratios, and questions that haven’t been fully answered yet. That’s how science is supposed to work. It doesn’t mean you should read it as a verdict on your own body.

If you notice that reading about health conditions reliably leads you to fear the worst about your own health, or that you spend significant time and energy monitoring your body for signs of illness, that pattern is worth exploring — not because there’s anything wrong with you, but because health anxiety is a recognized, treatable condition that affects many people living with chronic illness. A therapist who specializes in chronic illness or health anxiety can be a genuinely useful part of your care team.

You deserve information without terror. That’s what honest medicine looks like.