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Risk of Cardiovascular Disease Associated with a Restless Legs Syndrome Diagnosis in a Retrospective Cohort Study from Kaiser Permanente Northern California.
Sleep. 2015 Jul 01; 38(7):1009-15.S

Abstract

INTRODUCTION

Recent cross-sectional studies suggest that restless legs syndrome (RLS) may be associated with an increased prevalence of cardiovascular disease (CVD) comorbidity or risk factors. We evaluated whether primary or secondary RLS was associated with an increased risk of incident cardiovascular disease in a retrospective cohort study within Kaiser Permanente Northern California (KPNC).

METHODS

We identified members of KPNC with primary RLS and secondary RLS between 1999 and 2008 by an algorithm that incorporated longitudinal clinical records related to the diagnosis and treatment of RLS and comorbidities. We then matched each RLS case with up to 50 individuals with no clinical records of RLS by age, sex, race/ethnicity, zip code, and membership duration. For the analyses we excluded any individual with coronary artery disease (CAD: angina, acute myocardial infarction, coronary revascularization procedure, CAD death), CVD (CAD plus stroke), and hypertension at baseline. New cardiovascular events were determined from clinical records. Follow-up ended at an outcome event, disenrollment from KPNC, or death, whichever occurred earliest. There were over 473,358 person-y of follow-up in this cohort analysis with a mean follow-up time of 3.91 y and range from 6 mo to 12 y. Survival analysis techniques, including survival curves and proportional hazard regression models, were used to assess the association between RLS status and CVD.

RESULTS

There were 7,621 primary RLS and 4,507 secondary RLS cases identified and included in the study. In general, primary RLS cases were younger and had less comorbidity than secondary RLS cases. During the follow-up period, CVD was diagnosed in 478 primary RLS cohort members, CAD was diagnosed in 310, and hypertension events were identified in 1,466. Diagnosis in secondary RLS cohort members was made during the follow-up period with 451, 338, and 598 CVD, CAD, and hypertension events, respectively. Subjects with primary RLS had a similar risk of incident CVD (hazard ratio (HR) = 0.95; 95% confidence interval (CI) = 0.86-1.04) and CAD (HR = 0.99; 95% CI = 0.89-1.13) to the comparison cohort, with a slight elevation in the risk of hypertension events (HR = 1.19; 95% CI = 1.12-1.25), after multivariable adjustment. Individuals classified as secondary RLS had a significant increased risk of CVD (HR = 1.33; 95% CI = 1.21-1.46), CAD (HR = 1.40; 95% CI = 1.25-1.56), and hypertension (HR = 1.28; 95% CI = 1.18-1.40).

CONCLUSION

Primary restless legs syndrome (RLS) was not associated with new-onset cardiovascular disease (CVD) or coronary artery disease (CAD) but was associated with a slight increased risk of hypertension. In contrast, secondary RLS was associated with an increased risk of CVD, CAD, and hypertension.

Authors+Show Affiliations

Division of Research, Kaiser Permanente Northern California, Oakland, CA.Division of Research, Kaiser Permanente Northern California, Oakland, CA.Worldwide Epidemiology, GlaxoSmithKline, Research Triangle Park, NC and Stockley Park, UK.Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA.Division of Research, Kaiser Permanente Northern California, Oakland, CA.Division of Epidemiology, Department of Health Research and Policy, Stanford University, Stanford, CA.Division of Epidemiology, Department of Health Research and Policy, Stanford University, Stanford, CA.The Parkinson's Institute, Sunnyvale, CA.Worldwide Epidemiology, GlaxoSmithKline, Research Triangle Park, NC and Stockley Park, UK.Division of Research, Kaiser Permanente Northern California, Oakland, CA.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

26083613

Citation

Van Den Eeden, Stephen K., et al. "Risk of Cardiovascular Disease Associated With a Restless Legs Syndrome Diagnosis in a Retrospective Cohort Study From Kaiser Permanente Northern California." Sleep, vol. 38, no. 7, 2015, pp. 1009-15.
Van Den Eeden SK, Albers KB, Davidson JE, et al. Risk of Cardiovascular Disease Associated with a Restless Legs Syndrome Diagnosis in a Retrospective Cohort Study from Kaiser Permanente Northern California. Sleep. 2015;38(7):1009-15.
Van Den Eeden, S. K., Albers, K. B., Davidson, J. E., Kushida, C. A., Leimpeter, A. D., Nelson, L. M., Popat, R., Tanner, C. M., Bibeau, K., & Quesenberry, C. P. (2015). Risk of Cardiovascular Disease Associated with a Restless Legs Syndrome Diagnosis in a Retrospective Cohort Study from Kaiser Permanente Northern California. Sleep, 38(7), 1009-15. https://doi.org/10.5665/sleep.4800
Van Den Eeden SK, et al. Risk of Cardiovascular Disease Associated With a Restless Legs Syndrome Diagnosis in a Retrospective Cohort Study From Kaiser Permanente Northern California. Sleep. 2015 Jul 1;38(7):1009-15. PubMed PMID: 26083613.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Risk of Cardiovascular Disease Associated with a Restless Legs Syndrome Diagnosis in a Retrospective Cohort Study from Kaiser Permanente Northern California. AU - Van Den Eeden,Stephen K, AU - Albers,Kathleen B, AU - Davidson,Julie E, AU - Kushida,Clete A, AU - Leimpeter,Amethyst D, AU - Nelson,Lorene M, AU - Popat,Rita, AU - Tanner,Caroline M, AU - Bibeau,Kristen, AU - Quesenberry,Charles P, Y1 - 2015/07/01/ PY - 2013/07/22/received PY - 2015/01/31/accepted PY - 2015/6/18/entrez PY - 2015/6/18/pubmed PY - 2015/12/15/medline KW - cardiovascular disease KW - cohort study KW - epidemiology KW - restless legs syndrome SP - 1009 EP - 15 JF - Sleep JO - Sleep VL - 38 IS - 7 N2 - INTRODUCTION: Recent cross-sectional studies suggest that restless legs syndrome (RLS) may be associated with an increased prevalence of cardiovascular disease (CVD) comorbidity or risk factors. We evaluated whether primary or secondary RLS was associated with an increased risk of incident cardiovascular disease in a retrospective cohort study within Kaiser Permanente Northern California (KPNC). METHODS: We identified members of KPNC with primary RLS and secondary RLS between 1999 and 2008 by an algorithm that incorporated longitudinal clinical records related to the diagnosis and treatment of RLS and comorbidities. We then matched each RLS case with up to 50 individuals with no clinical records of RLS by age, sex, race/ethnicity, zip code, and membership duration. For the analyses we excluded any individual with coronary artery disease (CAD: angina, acute myocardial infarction, coronary revascularization procedure, CAD death), CVD (CAD plus stroke), and hypertension at baseline. New cardiovascular events were determined from clinical records. Follow-up ended at an outcome event, disenrollment from KPNC, or death, whichever occurred earliest. There were over 473,358 person-y of follow-up in this cohort analysis with a mean follow-up time of 3.91 y and range from 6 mo to 12 y. Survival analysis techniques, including survival curves and proportional hazard regression models, were used to assess the association between RLS status and CVD. RESULTS: There were 7,621 primary RLS and 4,507 secondary RLS cases identified and included in the study. In general, primary RLS cases were younger and had less comorbidity than secondary RLS cases. During the follow-up period, CVD was diagnosed in 478 primary RLS cohort members, CAD was diagnosed in 310, and hypertension events were identified in 1,466. Diagnosis in secondary RLS cohort members was made during the follow-up period with 451, 338, and 598 CVD, CAD, and hypertension events, respectively. Subjects with primary RLS had a similar risk of incident CVD (hazard ratio (HR) = 0.95; 95% confidence interval (CI) = 0.86-1.04) and CAD (HR = 0.99; 95% CI = 0.89-1.13) to the comparison cohort, with a slight elevation in the risk of hypertension events (HR = 1.19; 95% CI = 1.12-1.25), after multivariable adjustment. Individuals classified as secondary RLS had a significant increased risk of CVD (HR = 1.33; 95% CI = 1.21-1.46), CAD (HR = 1.40; 95% CI = 1.25-1.56), and hypertension (HR = 1.28; 95% CI = 1.18-1.40). CONCLUSION: Primary restless legs syndrome (RLS) was not associated with new-onset cardiovascular disease (CVD) or coronary artery disease (CAD) but was associated with a slight increased risk of hypertension. In contrast, secondary RLS was associated with an increased risk of CVD, CAD, and hypertension. SN - 1550-9109 UR - https://www.unboundmedicine.com/medline/citation/26083613/Risk_of_Cardiovascular_Disease_Associated_with_a_Restless_Legs_Syndrome_Diagnosis_in_a_Retrospective_Cohort_Study_from_Kaiser_Permanente_Northern_California_ L2 - https://academic.oup.com/sleep/article-lookup/doi/10.5665/sleep.4800 DB - PRIME DP - Unbound Medicine ER -