Abstract
Background
We investigated the association between hypertension, ischemic heart disease, heart failure, acute myocardial infarction, and atrial fibrillation with the risk of amyotrophic lateral sclerosis (ALS). This study also examined associations with use of angiotensin-converting enzyme inhibitors (ACEIs), angiotensin II receptors blockers (ARBs), calcium channel blockers, beta blockers, and antiarrhythmics
Methods
We conducted a population-based nested case-control study in the Medicare fee for service population, including 3,714 enrollees ages 65 and above with newly diagnosed ALS between 2006-2014. Cases were compared with 18,750 sex-, age, county, and enrollment-matched controls. Odds ratios (OR) and 95% Confidence Intervals (CIs) were estimated using conditional logistic regression models adjusting for diabetes, obesity, tobacco use, socioeconomic status, and controlling for confounding by indication. Medication use was identified through claims pharmacy data and similarly analyzed using a dose response approach.
Results
The fully adjusted OR for any CVD diagnosis was 0.93 (95% CI 0.86–1.02). Our results varied across cause-specific CVD diagnoses. We observed inverse associations for heart failure (OR 0.79; 95% CI 0.70–0.89) and atrial fibrillation (OR 0.81; 95% CI 0.76–0.92). ALS risk was reduced with use of ACEIs (OR 0.84; 95% CI 0.77–0.91), calcium channel blockers (OR 0.64; 95% CI 0.59–0.70), and beta blockers (OR 0.76; 95% CI 0.71–0.83).
Conclusions
In this large population-based Medicare study, the risk of ALS was 7% lower among individuals with any CVD diagnosis.
Key messages
Our findings suggest having a cardiovascular condition or use of a CVD medication may be protective for ALS.
Risk of major bleeding at different PT-INR ranges in elderly Japanese patients with non-valvular atrial fibrillation receiving warfarin: a nested case-control study
