Cardiovascular disease and diagnosis of amyotrophic lateral sclerosis: A population based study

Abstract

Amyotrophic lateral sclerosis (ALS) is a rapidly fatal neurodegenerative disease of unknown etiology. We investigated the association between ALS diagnosis and prior cardiovascular disease (CVD), and CVD-specific, hospital admissions in the Danish population. We conducted a population based nested case-control study, including 3182 Danish residents diagnosed with ALS at age ≥20 years (1982-2009) and 100 randomly selected controls for each case, matched on age, gender and vital status. We estimated odds ratios (OR) associated with CVD, and CVD-specific hospital admissions, adjusting for socioeconomic and marital status, region of residence and past diabetes and obesity diagnoses. The estimated adjusted OR for any CVD admission at least three years prior to the date of ALS diagnosis was 1.15 (95% CI 1.04-1.27). Our results varied across cause-specific admissions; for atherosclerosis the OR was 1.36 (95% CI 1.02-1.80) and for ischemic heart disease 1.14 (95% CI 0.99-1.31), while we observed no association with hypertensive and cerebrovascular diseases. Adjusting for or stratifying by COPD status, a cigarette-smoking correlate, did not change our results. In conclusion, in our population based study we found evidence for a moderately elevated association with CVD that was stronger for specific conditions, such as atherosclerosis. Our findings may have important implications for ALS pathogenesis.

Keywords: Amyotrophic lateral sclerosis (ALS); atherosclerosis; cardiovascular disease (CVD); ischemic heart disease.

Figure 1

Estimated adjusted odds ratios and 95% confidence intervals for the observed association between CVD and ALS (open circle) and after artificially delaying by the number of months indicated the ALS diagnosis date (or index date) among cases with CVD and their corresponding controls using a bootstrap process (closed circle), as described in the Sensitivity Analyses in the Methods section. The presented associations are adjusted for socio-economic status, marital status, region of residence and diabetes, COPD and obesity diagnoses.