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Cardiovascular physiology in premotor Parkinson's disease: A neuroepidemiologic study [Note a. a Analyses were stratified by sex only if it ...]
Author(s) -
Jain Samay,
Ton Thanh G.,
Perera Subashan,
Zheng Yan,
Stein Phyllis K.,
Thacker Evan,
Strotmeyer Elsa S.,
Newman Anne B.,
Longstreth Will T.
Publication year - 2012
Publication title -
movement disorders
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.352
H-Index - 198
eISSN - 1531-8257
pISSN - 0885-3185
DOI - 10.1002/mds.24979
Subject(s) - medicine , cardiology , asymptomatic , body mass index , heart rate , odds ratio , logistic regression , stenosis , stroke (engine) , blood pressure , abnormality , diabetes mellitus , cohort , framingham heart study , disease , physical therapy , framingham risk score , endocrinology , mechanical engineering , psychiatry , engineering
Changes in cardiovascular physiology in Parkinson's disease (PD) are common and may occur prior to diagnostic parkinsonian motor signs. We investigated associations of electrocardiographic (ECG) abnormalities, orthostasis, heart rate variability, and carotid stenosis with the risk of PD diagnosis in the Cardiovascular Health Study, a community‐based cohort of older adults. ECG abnormality, orthostasis (symptomatic or asymptomatic), heart rate variability (24‐hour Holter monitoring), and any carotid stenosis (≥1%) by ultrasound were modeled as primary predictors of incident PD diagnosis using multivariable logistic regression. Incident PD cases were identified by at least 1 of the following: self‐report, antiparkinsonian medication use, and ICD‐9. If unadjusted models were significant, they were adjusted or stratified by age, sex, and smoking status, and those in which predictors were still significant ( P ≤ .05) were also adjusted for race, diabetes, total cholesterol, low‐density lipoprotein, blood pressure, body mass index, physical activity, education level, stroke, and C‐reactive protein. Of 5888 participants, 154 incident PD cases were identified over 14 years of follow‐up. After adjusting models with all covariates, those with any ECG abnormality (odds ratio [OR], 1.45; 95% CI, 1.02–2.07; P = .04) or any carotid stenosis (OR, 2.40; 95% CI, 1.40–4.09; P = .001) at baseline had a higher risk of incident PD diagnosis. Orthostasis and heart rate variability were not significant predictors. This exploratory study suggests that carotid stenosis and ECG abnormalities occur prior to motor signs in PD, thus serving as potential premotor features or risk factors for PD diagnosis. Replication is needed in a population with more thorough ascertainment of PD onset. © 2012 Movement Disorder Society