Brain Advance Access published online on March 9, 2005
Brain, doi:10.1093/brain/awh471
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1 Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA
* To whom correspondence should be addressed. Summary An increased risk of multiple sclerosis among smokers has been found in several prospective epidemiological studies. The association between smoking and progression of multiple sclerosis has not been examined. We identified patients who had a first multiple sclerosis diagnosis recorded in the General Practice Research Database (GPRD) between January 1993 and December 2000. Their diagnosis and date of first symptoms were confirmed through examination of medical records. Smoking status was obtained from the computer records. To assess the association between smoking and risk of multiple sclerosis, we conducted a case-control study nested in the GPRD. Up to 10 controls per case were randomly selected, matched on age, sex, practice, date of joining the practice and availability of smoking data. To assess the association between smoking and progression of multiple sclerosis, we conducted a cohort study of multiple sclerosis cases with a relapsing-remitting onset. Our nested case-control study included 201 cases of multiple sclerosis and 1913 controls. The odds ratio [95% confidence interval (CI)] of multiple sclerosis was 1.3 (1.0-1.7) for ever smokers compared with never smokers. Our cohort study included 179 cases with a mean (median) length of follow-up of 5.3 (5.3) years. The hazard ratio of secondary progression was 3.6 (95% CI 1.3-9.9) for ever smokers compared with never smokers. These results support the hypothesis that cigarette smoking is associated with an increased risk of multiple sclerosis, and suggest that smoking may be a risk factor for transforming a relapsing-remitting clinical course into a secondary progressive course.
Received October 30, 2004
Revised January 11, 2005
Accepted February 7, 2005
Article
Cigarette smoking and the progression of multiple sclerosis
2 Boston Collaborative Drug Surveillance Program, Boston University, Lexington, MA, USA
3 Department of Neurology, College of Medicine, University of California, Irvine, CA, USA
4 Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA; Department of Nutrition, Harvard School of Public Health, Boston, MA, USA; Channing Laboratory, Brigham and Women's Hospital, Boston, MA, USA
Miguel A. Hernán, E-mail: miguel_hernan{at}post.harvard.edu
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