Introduction: We investigated the associations between antecedent all-cause CVD diagnoses, cause-specific CVD diagnosis, and CVD medication prescriptions with the risk of developing amyotrophic lateral sclerosis (ALS). Materials and Methods: We conducted a population-based case-control study of U.S. Medicare enrollees from 2006 to 2013. The final sample included 3,714 incident ALS cases and 18,570 controls (matched on age, sex, enrollment length, and county). Information was collected from Medicare Parts A, B, and D administrative claims data on hypertension, ischemic heart disease, heart failure, acute myocardial infarction, atrial fibrillation, prescriptions of angiotensin-converting enzyme inhibitors, angiotensin II receptors blockers, calcium channel blockers, beta blockers, and antiarrhythmics. Associations were evaluated using conditional logistic regression adjusting for age, sex, race/ethnicity, geographical location, alcohol and tobacco use, and socioeconomic status. Results: The odds ratio (OR) for having one or more ICD-9 codes for any cardiovascular disease diagnosis at least 24 months prior to the date of ALS diagnosis was 0.85 (95% conifidence interval [CI]: 0.78-0.92). Cardiovascular conditions that were inversely associated with ALS included heart failure (OR = 0.79; 95% CI 0.70-0.89), atrial fibrillation (OR = 0.81; 95% CI 0.77-0.92), and hypertension (OR = 0.91; 95% CI 0.84-0.98). Exposures to several classes of cardiovascular medications were inversely associated with ALS risk even after adjusting for confounding by indication, including ACE inhibitors (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). Discussion/Conclusion: These findings merit additional research, including animal studies and pilot clinical trials, to further evaluate and evidence the effects of ACEIs, CCBs, and BBs on the risk of developing and clinical expression of ALS.
|Number of pages||10|
|State||Published - Feb 1 2023|
Bibliographical noteFunding Information:
This study was funded by a grant from Centers for Disease Control and Prevention (Agency for Toxic Substances and Disease Registries), Grant No. R01TS000249.
Dr. Lorene Nelson receives grants from the National Institutes of Health, National MS Society, and Centers for Disease Control. Dr. Nelson receives compensation for serving as a consultant to Acumen, Inc. Dr. Kasarskis receives support for clinical ALS trials from the Healey platform trial program, AB Science, Alexion, and Amylx. Dr. Kasarskis also receives support from the Crispen and Team 7 endowments for ALS research. All other authors have no conflicts of interest to declare.
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- Amyotrophic lateral sclerosis
- Angiotensin-converting enzyme inhibitors
- Cardiovascular disease
ASJC Scopus subject areas
- Clinical Neurology