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Is cardiovascular disease a risk factor in the development of axonal polyneuropathy?
  1. L L Teunissen1,
  2. H Franssen2,
  3. J H J Wokke1,
  4. Y van der Graaf3,
  5. W H J P Linssen4,
  6. J D Banga5,
  7. D M Laman6,
  8. N C Notermans1
  1. 1Department of Neurology, University Medical Centre, Utrecht, The Netherlands
  2. 2Clinical Neurophysiology, University Medical Centre, Utrecht
  3. 3Julius Centre for Patient Oriented Research, University Medical Centre, Utrecht
  4. 4Department of Neurology, St Lucas Andreas Hospital, Amsterdam, The Netherlands
  5. 5Department of Internal Medicine, University Medical Centre, Utrecht
  6. 6Department of Clinical Neurophysiology, St Lucas Andreas Hospital
  1. Correspondence to:
 Dr Teunissen, University Medical Centre Utrecht, Department of Neurology, G03.236, PO Box 85500, 3508 GA Utrecht, The Netherlands;


Objectives: To determine if cardiovascular disease may be a risk factor in the development of chronic idiopathic axonal polyneuropathy (CIAP).

Methods: In this incidence case-control study, the prevalence of cardiovascular disease and risk factors in 97 patients with CIAP (mean age 67.5 (SD 7.9) years) and the prevalence of neuropathic features in 97 patients with peripheral arterial disease (PAD) (mean age 67.1 (SD 7.3) years) were investigated. The results were compared with those for 96 age and sex matched controls without diagnosed PAD or polyneuropathy (mean age 67.5 (SD 9.1) years). In a randomly chosen subgroup of 23 patients with CIAP, 42 patients with PAD, and 48 controls, an electrodiagnostic investigation was performed.

Results: Patients with CIAP more often had manifest cardiovascular disease and cardiovascular risk factors than controls (stroke 18% v 6% of patients, odds ratio (OR) 3.2 (95% confidence interval (CI) 1.8 to 5.9); heart disease 29% v 15%, OR 2.4 (95% CI 1.2 to 4.9); family history of cardiovascular disease 42% v 21%, OR 2.8 (95% CI (1.5 to 5.2); hypertension 56% v 39%, OR 2.0 (95% CI 1.1 to 3.6); hypercholesterolaemia 46% v 21%, OR 3.3 (95% CI 1.5 to 7.3); current smoking 38% v 23%, OR 2.1 (95% CI 1.1 to 3.9)). The prevalence of cardiovascular disease and cardiovascular risk factors was lower than in patients with PAD. Patients with PAD more often had polyneuropathy than controls (15% v 5%, OR 3.3 (95% CI 1.1 to 10.0)). There was a trend towards lower nerve conduction velocities and lower amplitudes on electrodiagnostic investigation compared with controls.

Conclusion: This study shows that cardiovascular disease and CIAP often coexist, and therefore cardiovascular disease may be a cofactor in the development of CIAP.

  • chronic idiopathic axonal polyneuropathy
  • peripheral arterial disease
  • cardiovascular disease
  • CIAP, chronic idiopathic axonal polyneuropathy
  • PAD, peripheral arterial disease
  • TIA, transient ischaemic attack
  • CMAP, compound muscle action potential
  • SNAP, sensory nerve action potential
  • BMI, body mass index

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