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Research paper
Cardiovascular fitness as a risk factor for amyotrophic lateral sclerosis: indirect evidence from record linkage study
  1. Martin R Turner1,
  2. Clare Wotton2,
  3. Kevin Talbot1,
  4. Michael J Goldacre2
  1. 1Oxford University, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK
  2. 2Oxford University, Unit of Health-Care Epidemiology, Department of Public Health, Oxford, UK
  1. Correspondence to Dr M R Turner, Nuffield Department of Clinical Neurosciences, West Wing Level 3, John Radcliffe Hospital, Oxford OX3 9DU, UK; martin.turner{at}


Background Amyotrophic lateral sclerosis (ALS) appears to be a sporadic disorder in 95% of cases. Although few personal characteristics associated with developing ALS are known, identification of those at risk is essential to any vision of early intervention. There is persistent anecdotal observation that those with ALS are premorbidly physically ‘fitter’, although such observations are susceptible to bias. Hospital admission for coronary heart disease (CHD) might serve as an objective marker of reduced cardiovascular fitness.

Methods A record linkage study of two large databases of hospital admissions, the Oxford Record Linkage Study (ORLS) and an English national record linkage dataset of Hospital Episode Statistics was undertaken. The ratio of the rate of ALS in people without a record of CHD to that in those with a record of CHD was calculated, factoring out premature death in both cohorts. Similar analysis for Parkinson's disease (PD) and multiple sclerosis (MS) was undertaken.

Results In the English population, the rate ratio for ALS in the non-CHD cohort, compared with the CHD cohort, was 1.14 (95% CI 1.05 to 1.22); for PD it was 0.95 (95% CI 0.93 to 0.98); and for MS 0.95 (95% CI 0.88 to 1.04). The ORLS data yielded similar findings.

Conclusions Those without a record of CHD were at modestly higher risk of ALS, but not for PD or MS. This lends support to the assertion that ALS arises within a population who may have relatively higher levels of cardiovascular fitness.

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  • This article conforms to STROBE guidelines.

  • Funding This work was supported by the Medical Research Council/Motor Neurone Disease Association Lady Edith Wolfson Fellowship (grant No G0701923) to MRT.

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The authors adhere to the Medical Research Council policy on data sharing whereby data arising from MRC funded research should be made available to the scientific community with as few restrictions as possible.