ASCVD Linked to Higher Risk for ALS

TOPLINEIndividuals with a history of atherosclerotic cardiovascular disease (ASCVD), particularly coronary artery disease (CAD) and ischemic stroke (IS), had a higher risk for amyotrophic lateral sclerosis (ALS) than those without ASCVD, with more pronounced associations observed in individuals aged 65 years or younger, a study showed. Conversely, individuals with optimal cardiovascular health (CVH) had a lower risk for ALS than those with low CVH.METHODOLOGYResearchers conducted a prospective cohort study using linked electronic health record data of 502,279 participants from the UK Biobank, who were aged 37-73 years at baseline.A total of 57,805 participants had a history of ASCVD at baseline, including 27,256 with CAD, 7582 with IS, and 31,528 with peripheral artery disease (PAD).CVH was quantified using Life's Essential 8 (LE8) scores and categorized as low (0-59), moderate (60-79), or high (80-100).The primary outcome was incident ALS, ascertained using records of hospital admissions, death, or primary health care.The median follow-up was 13.74 years. The analysis was adjusted for age, sex, BMI, Townsend deprivation index, education level, ethnicity, smoking status, drinking status, sleep duration, and physical activity.TAKEAWAYOver the follow-up period, 675 individuals developed ALS. Individuals with a history of ASCVD had a higher risk for ALS than those without ASCVD (adjusted hazard ratio [aHR], 1.43; P = .001), with the association driven by CAD (aHR, 1.53; P = .003) and IS (aHR, 1.82; P = .013). PAD was not significantly associated with the risk for ALS.Individuals who had ASCVD for more than 5 years at baseline had a higher risk for ALS than those without a history of ASCVD (aHR, 1.61; P < .001), with similar associations seen for CAD (aHR, 1.78; P < .001) and IS (aHR, 2.37; P = .002).Among participants aged 65 years or younger, a higher risk for ALS was observed in those with a history of ASCVD (aHR, 1.65; P < .001), CAD (aHR, 1.93; P < .001), or IS (aHR, 2.26; P = .003). No significant associations were seen for individuals older than 65 years. High CVH was associated with a 48% lower risk for ALS than low CVH (aHR, 0.52; P = .004); each 1-point increase in the LE8 score was associated with a 14% lower risk (aHR, 0.86; P = .029). When joint associations between ASCVD, CVH, and ALS were assessed in participants aged 65 years or younger, among other subgroups, the subgroup with low CVH and pre-existing ASCVD had the highest risk for ALS (HR, 2.40; P = .014) compared to that with high CVH and no ASCVD.IN PRACTICE"These findings support a potential link between CVH and ALS susceptibility, particularly among individuals aged ≤65 years," the authors wrote.SOURCEThe study was led by Jiali Xie, MD, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China, and Haobo Xie, MS, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, People's Republic of China. It was published online on September 12 in the Annals of Neurology.LIMITATIONSThe study was limited by potential reverse causality, lack of evaluation of longitudinal cardiovascular changes, reliance on linked health records and diagnostic codes for identifying ALS, a cohort with mostly European ancestry, and residual pleiotropic effects.DISCLOSURESThe study was funded by the Natural Science Foundation of Zhejiang Province, Hebei Key Laboratory of Neurology, and the Innovative Drug Research and Development National Science and Technology Major Project. The authors reported no relevant conflicts of interest.This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.