Clinical research study
Vascular Risk Factors, Cardiovascular Disease, and Restless Legs Syndrome in Men

https://doi.org/10.1016/j.amjmed.2012.06.039Get rights and content

Abstract

Background

The prevalence of vascular risk factors, cardiovascular disease, and restless legs syndrome increases with age. Prior studies analyzing the associations between vascular risk factors, cardiovascular disease, and restless legs syndrome found controversial results. We therefore aim to evaluate the associations between prevalent vascular risk factors, prevalent cardiovascular disease, and restless legs syndrome.

Methods

We conducted a cross-sectional study among 22,786 participants of the US Physicians' Health Studies I and II. Restless legs syndrome was classified according to the 4 minimal diagnostic criteria. Vascular risk factors and restless legs syndrome symptoms were self-reported. Prevalent cardiovascular disease events, including major cardiovascular disease, stroke, and myocardial infarction, were confirmed by medical record review. Age- and multivariable-adjusted logistic regression models were used to evaluate the association among vascular risk factors, prevalent cardiovascular disease events, and restless legs syndrome.

Results

The mean age of the cohort was 67.8 years. The prevalence of restless legs syndrome was 7.5% and increased significantly with age. Diabetes significantly increased the odds of restless legs syndrome (odds ratio [OR], 1.41; 95% confidence interval [CI], 1.21-1.65), whereas frequent exercise (OR, 0.78; 95% CI, 0.67-0.91) and alcohol consumption of 1 or more drinks per day (OR, 0.80; 95% CI, 0.69-0.92) significantly reduced the odds of restless legs syndrome in multivariable-adjusted models. Prevalent stroke showed an increased multivariable-adjusted OR of 1.40 (1.05-1.86), whereas men with prevalent myocardial infarction had a decreased OR of 0.73 (0.55-0.97) for restless legs syndrome.

Conclusions

The restless legs syndrome prevalence among US male physicians is similar to that of men of the same age group in other western countries. A history of diabetes is the most consistent risk factor associated with restless legs syndrome. Prevalent stroke and myocardial infarction are related to restless legs syndrome prevalence.

Section snippets

Study Population

The PHS I was a randomized trial to test the benefits and risks of low-dose aspirin (325 mg) and beta-carotene (50 mg) in the primary prevention of cardiovascular disease and cancer among 22,071 apparently healthy physicians aged 40 to 84 years at baseline in 1982.8, 9 Baseline information was self-reported and collected by means of a mailed questionnaire that asked about many vascular risk factors and lifestyle variables. Every 6 months in the first year and yearly thereafter, follow-up

Results

The overall prevalence of restless legs syndrome in this cohort of 22,786 US male physicians was 7.5%. The prevalence increased significantly with age from 6.2% in those aged less than 60 years to 9.8% in those aged 80 years or more. The prevalence did not vary significantly by geographic location.

Discussion

In this large cohort of US male physicians, we found an overall restless legs syndrome prevalence of 7.5%, which steadily increased with advancing age. Men who had a history of diabetes were more likely to have restless legs syndrome. Restless legs syndrome prevalence was reduced for participants who consumed 1 or more alcoholic drinks per day and for those who exercised regularly. Prevalent stroke and myocardial infarction were both associated with restless legs syndrome but in opposite

Conclusions

In this large study of US physicians, the prevalence of restless legs syndrome was comparable to that of men in other western countries. We do not find strong and consistent associations of restless legs syndrome with most vascular risk factors. The most consistent factor is diabetes. Prevalent stroke and myocardial infarction (inverse) were associated with restless legs syndrome. Further targeted research is warranted to disentangle the time of onset of restless legs syndrome in relation to

Acknowledgments

The authors thank the participants in the PHS for outstanding commitment and cooperation, and the entire PHS staff for expert and unfailing assistance.

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    Funding: This study was supported by a grant from the National Heart, Lung, and Blood Institute (HL-091880). The Physicians' Health Study is supported by grants from the National Cancer Institute (CA-34944, CA-40360, and CA-097193) and the National Heart, Lung, and Blood Institute (HL-26490 and HL-34595).

    Conflict of Interest: Dr Winter has received an international postdoctoral research fellowship of the American Association of University Women and a research fellowship of the German Research Foundation. Dr Schürks has received an investigator-initiated research grant from the Migraine Research Foundation. He has received honoraria from L.E.K. Consulting for telephone surveys and from the American Academy of Neurology for educational material. Since August 2011, he has been a full-time employee of Bayer HealthCare Pharmaceuticals, Germany. Dr Glynn has received investigator-initiated research funding and support from the National Institutes of Health, AstraZeneca, and Novartis; and has received honoraria from Merck for lectures. Dr Buring has received investigator-initiated research funding and support from the National Institutes of Health and Dow Corning Corporation; research support for pills or packaging from Bayer HealthCare and the Natural Source Vitamin E Association. Dr Gaziano has received investigator-initiated research funding and support as Principal Investigator from the National Institutes of Health, BASF, DSM Pharmaceuticals, Wyeth Pharmaceuticals, McNeil Consumer Products, and Pliva; received honoraria from Bayer and Pfizer for speaking engagements, and is a consultant for Bayer, McNeil Consumer Products, Wyeth Pharmaceuticals, Merck, Nutraquest, and GlaxoSmithKline. Dr Berger has received investigator-initiated research funding as principal or coordinating investigator in the areas of diabetes, depression and subclinical atherosclerosis, multimorbidity, and health services research from the German Ministry of Research and Technology (BMBF). In addition, for the conduction of an ongoing study on the Course of Restless Legs Syndrome he has received unrestricted grants to the University of Muenster from the German Restless Legs Society and a consortium with equal shares formed by Boehringer Ingelheim Pharma, Mundipharma Research, Neurobiotec, UCB Germany and Switzerland, Vifor Pharma, and Roche Pharma. Dr Kurth has received investigator-initiated research funding from the French National Research Agency, the US National Institutes of Health, Merck, the Migraine Research Foundation, and the Parkinson's disease Foundation. He has received honoraria from the BMJ for editorial work, from Allergan, the American Academy of Neurology and Merck for educational lectures, and from MAP Pharmaceutical for contributing to a scientific advisory panel.

    Authorship: All authors had access to the data and played a role in writing this manuscript.

    ACW and KB contributed equally to the work.

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