Association of Parkinson Disease With Risk of Cardiovascular Disease and All-Cause Mortality
Authors: Joo-Hyun Park, Do-Hoon Kim, Yong-Gyu Park, Do-Young Kwon, Moonyoung Choi, Jin-Hyung Jung, Kyungdo Han
Journal: Circulation (2020)

disease ◼ Parkinson disease ◼ stroke P arkinson disease (PD) is the second most common neurodegenerative disorder and affects 1% to 3% of people aged >65 years.As life expectancy increases, the prevalence and burden of PD increase worldwide. 1Although epidemiologic studies have consistently reported high PD-associated mortality, 2 the relationship between PD and cardiovascular diseases (CVDs), the leading cause of death, remains unclear.CVDs, such as myocardial infarction (MI), ischemic stroke, and congestive heart failure (CHF), are the most common medical conditions in older people.Although several studies have investigated the relationship between PD and CVD, the results remain controversial.Therefore, we conducted a nationwide, population-based cohort study to evaluate the risk of MI, ischemic stroke, CHF, and all-cause mortality in PD patients.We obtained data from the National Health Insurance Service and national rare intractable disease registry database, which covers the entire Korean population.Patients newly diagnosed with PD and individuals without PD who were aged ≥40 years from 2010 to 2015 were included from the database.However, individuals previously diagnosed with MI, ischemic stroke, CHF, and PD before 2010 were excluded.Finally, the PD group was matched 1:5 with the non-PD group with respect to age and sex, and 25 624 and 128 120 individuals were included in the PD and non-PD groups, respectively.Each patient was observed until 2016, and occurrences of MI, ischemic stroke, CHF, and all-cause death were recorded.PD was identified based on the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) code for PD (G20) and the PD registration code (V124) in the registry of rare intractable diseases, whose uniform diagnostic criteria are almost identical to the United Kingdom Parkinson's Disease Society Brain Bank diagnostic criteria.The definitions of outcomes were as follows: ICD-10-CM-codes I21 and I22 during hospitalization for MI, ICD-10-CM-codes I63 and I64 during hospitalization, with ≥1 brain computed tomography or magnetic resonance imaging for ischemic stroke, and ICD-10-CM-codes I50 for CHF.To evaluate the high risk of MI, ischemic stroke, CHF and all-cause mortality in PD patients, we determined hazard ratios (HRs) and 95% CIs using Cox proportional hazards regression model.We adjusted for the following covariates: age, sex, household income (lowest quartile and remaining quartiles), hypertension (ICD-10-CM-codes I10-13 and I15 and antihypertensive agents), diabetes mellitus (ICD-10-CM-codes E11-E14 and oral antidiabetic agents or insulin), dyslipidemia (ICD-10-CM-code E78 and agents for dyslipidemia), chronic obstructive pulmonary disease (ICD-10-CM-codes J41-J44), and end-stage renal disease (ICD-10-CMcodes N18, N19, Z49, Z940, Z90, and Z992 and claims for hemodialysis, peritoneal dialysis, or renal transplantation).All statistical analyses were performed using SAS version 9.