Blood Pressure Meds Tied to Lower ALS Risk
November 12, 2014 - als
In a investigate involving a whole adult race of Taiwan, people with amyotrophic parallel sclerosis (ALS) were significantly reduction expected to have used supposed ACE inhibitors before to diagnosis than differently identical people in a ubiquitous population, researchers said.
Among people whose sum ACE inhibitor bearing over a 4-year duration exceeded 449.5 times a generally supposed daily dosage, a contingency ratio for building ALS in year 5 was 0.43 (95% CI 0.26-0.72) relations to nonusers of these medications, according to Charles Tzu-Chi Lee, PhD, of Kaohsiung Medical University Hospital in Taiwan, and colleagues.
The researchers also reported anticipating a dose-response relationship, in that people who used ACE inhibitors though whose accumulative bearing fell brief of a same threshold had a nonsignificantly reduced risk of successive ALS diagnosis contra nonusers (OR 0.83, 95% CI 0.65-1.07).
“Our investigate suggests that ACE inhibitor use has a intensity purpose in a impediment of ALS,” Lee and colleagues wrote online in JAMA Neurology, nonetheless they concurred that a investigate was singular by a retrospective pattern and a faith on executive records, among other factors.
The researchers sought to inspect a probable attribute between ACE inhibitor use and ALS risk since several before studies, both in humans and in animals, have suggested that a drugs — ordinarily prescribed to soothe hypertension — might have neurotrophic and neuroprotective effects. One rodent study, for example, indicated that one such representative topsy-turvy engine neuron damage, suggesting a probable aptitude to ALS.
Taiwan’s concept health word module offering a approach to inspect a probability in a vast population, Lee and colleagues wrote, insofar as it had enrolled some 23 million people national — 99.6% of a race — as of 2010, with extensive annals of medical diagnoses and drugs dispensed.
Out of this vast number, Lee and colleagues identified 729 patients with newly diagnosed ALS and matched them on a basement of sex, age, place of residence, and word reward form (a pen of practice status) to 14,580 non-ALS individuals. Their annals of drug prescriptions filled were examined in a years before to ALS diagnosis in a studious group, and before to a analogous index date in a matched controls.
Besides ACE inhibitor use, a researchers also looked during other common remedy types, including other blood vigour reducers, nonsteroidal anti-inflammatory drugs (NSAIDs), aspirin, and corticosteroids.
Histories of ACE inhibitor use were significantly reduction common in a ALS patients compared with controls: 15.23% of a patients had perceived such medications, contra 17.99% of a controls. About half as many ALS patients had taken some-more than 449.5 “cumulative tangible daily doses (cDDD) of these drugs as did controls. (Lee and colleagues formed a cDDD values on published endorsed doses for any ACE inhibitor — for example, 50 mg/day for captopril and 10 mg/day for enalapril.)
None of a other remedy classes showed a probable protecting effect, nonetheless a aloft suit of controls contra patients had bearing to aspirin, a disproportion that was equivocal poignant (P=0.05). Users of other NSAIDs, on a other hand, were some-more expected to be diagnosed with ALS (P=0.03) in unadjusted analyses nonetheless a outcome distance was comparatively modest.
After statistical adjustments for factors such Charlson comorbidity measure and sanatorium admissions, light bearing to aspirin (less than 2.4 cDDD) seemed to strengthen opposite ALS (OR 0.70, 95% CI 0.55-0.89) though heavier bearing did not. And a usually other remedy form to uncover a poignant organisation was ACE inhibitor bearing above 449.5 cDDD.
Factors modifying a attribute between ACE inhibitor bearing and ALS risk enclosed sex (the apparent protecting outcome was strong in males) and age (only those 55 and comparison showed a poignant relationship). On a other hand, there were really few younger patients with high ACE inhibitor bearing and, in those 15 to 54 years old, a contingency ratio for ALS among those with some-more than 449.5 cDDD was 0.49 (95% CI 0.15-1.65).
Besides a retrospective pattern and faith on executive records, investigate stipulations enclosed miss of information on intensity confounders such as smoking status, ethanol intake, and vitamin E levels and addition usage.
Lee and colleagues endorsed additional impending studies to endorse a protecting outcome for ACE inhibitors, that could also embody aspirin.
The investigate had no outmost funding.
Authors announced they had no applicable financial interests.
Primary source: JAMA Neurology
Source reference: Lee C, et al “Angiotensin-converting enzyme inhibitors and amyotrophic parallel sclerosis risk; A sum population–based case-control study” JAMA Neurology 2014; doi: 10.1001/jamaneurol.2014.3367.