title: Prior medical conditions and the risk of amyotrophic lateral sclerosis.
abstract: Sporadic amyotrophic lateral sclerosis (ALS) is believed to be a complex disease in which multiple exogenous and genetic factors interact to cause motor neuron degeneration. Elucidating the association between medical conditions prior to the first symptoms of ALS could lend support to the theory that specific subpopulations are at risk of developing ALS and provide new insight into shared pathogenic mechanisms. We performed a population-based case-control study in the Netherlands, including 722 sporadic ALS patients and 2,268 age and gender matched controls. Data on medical conditions and use of medication were obtained through a structured questionnaire. Multivariate analyses showed that hypercholesterolemia (OR 0.76, 95% CI 0.63-0.92, P = 0.006), the use of statins (OR 0.45, 95% CI 0.35-0.59, P = 1.86 × 10(-9)) or immunosuppressive drugs (OR 0.26, 95% CI 0.08-0.86, P = 0.03) were associated with a decreased risk of ALS. Head trauma was associated with an increased ALS susceptibility (OR 1.95, 95% CI 1.11-3.43, P = 0.02). No association was found with autoimmune diseases, cancer, psychiatric disorders or cardiovascular diseases, or survival. The lower frequency of hypercholesterolemia and less use of statins in ALS patients indicate a favorable lipid profile prior to symptom onset in at least a subpopulation of ALS. Prior head trauma is a risk factor for ALS and the significantly lower use of immunosuppressive drugs in ALS patients could suggest a protective effect. The identification of specific subpopulations at risk for ALS may provide clues towards possible pathogenic mechanisms.
authors: Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
authors: Meinie
authors: M
authors: Seelen
authors: Perry T C
authors: PT
authors: van Doormaal
authors: Anne E
authors: AE
authors: Visser
authors: Mark H B
authors: MH
authors: Huisman
authors: Margot H J
authors: MH
authors: Roozekrans
authors: Sonja W
authors: SW
authors: de Jong
authors: Anneke J
authors: AJ
authors: van der Kooi
authors: Marianne
authors: M
authors: de Visser
authors: Nicol C
authors: NC
authors: Voermans
authors: Jan H
authors: JH
authors: Veldink
authors: Leonard H
authors: LH
authors: van den Berg
mesh_terms: D017668:Age of Onset; D000368:Aged; D000690:Amyotrophic Lateral Sclerosis / Q000453:epidemiology* / Q000209:etiology*; D001327:Autoimmune Diseases / Q000150:complications; D002318:Cardiovascular Diseases / Q000150:complications; D016022:Case-Control Studies; D018672:Community Health Planning; D006259:Craniocerebral Trauma / Q000150:complications; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000009:adverse effects*; D006937:Hypercholesterolemia / Q000150:complications*; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D008297:Male; D001523:Mental Disorders / Q000150:complications; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D012189:Retrospective Studies; D012306:Risk; D011795:Surveys and Questionnaires
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D007166:Immunosuppressive Agents