Association of ALS with head injury, cigarette smoking and APOE genotypes.
OBJECTIVE
An increased risk of ALS has been reported for US veterans, but the cause is unknown. Since head injury and cigarette smoking are two previously implicated environmental risk factors that are more common in military than civilian study populations, we tested their association with ALS in a US veteran study population.


METHODS
We used logistic regression to examine the association of ALS with head injury and cigarette smoking in 241 incident cases and 597 controls. Since APOE is a plausible ALS candidate gene, we also tested its main effect and its statistical interaction with these environmental exposures.


RESULTS
Cigarette smoking was not associated with ALS in this predominantly male and Caucasian population. Veterans who had experienced head injuries during the last 15years before the reference date had an adjusted odds ratio of 2.33 (95% confidence interval 1.18-4.61), relative to veterans without any head injuries. This association was strongest in APOE-4 carriers.


CONCLUSIONS
Our results add to the body of evidence suggesting that head injuries may be a risk factor for multiple neurodegenerative diseases, including ALS. We hypothesize that the strength of association between head injuries and ALS may depend upon APOE genotype.
Schmidt
Silke
S
Center for Human Genetics, Duke University Medical Center, 595 Lasalle Street, Durham, North Carolina, 27710, USA. silke.schmidt@duke.edu
Kwee
Lydia Coulter
LC
Allen
Kelli D
KD
Oddone
Eugene Z
EZ
D000690:Amyotrophic Lateral Sclerosis / Q000453:epidemiology* / Q000235:genetics*; D053327:Apolipoprotein E4 / Q000235:genetics; D001057:Apolipoproteins E / Q000235:genetics*; D006259:Craniocerebral Trauma / Q000453:epidemiology*; D004781:Environmental Exposure; D005260:Female; D020022:Genetic Predisposition to Disease; D005838:Genotype; D006579:Heterozygote; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology*; D014481:United States / Q000453:epidemiology; D014728:Veterans; D044465:White People
D053327:Apolipoprotein E4; D001057:Apolipoproteins E