@article{3141932,
    title = "Smoking and Risk for Amyotrophic Lateral Sclerosis: Analysis of the EPIC
Cohort",
    author = "Gallo, Valentina and Bueno-de-Mesquita, H. Bas and Vermeulen, Roel and and Andersen, Peter M. and Kyrozis, Andreas and Linseisen, Jakob and Kaaks, and Rudolph and Allen, Naomi E. and Roddam, Andrew W. and Boshuizen, and Hendrick C. and Peeters, Petra H. and Palli, Domenico and Mattiello, and Amalia and Sieri, Sabina and Tumino, Rosario and Jimenez-Martin, and Juan-Manuel and Tormo Diaz, Maria Jose and Rodriguez Suarez, Laudina and and Trichopoulou, Antonia and Agudo, Antonio and Arriola, Larraitz and and Barricante-Gurrea, Aurelio and Bingham, Sheila and Khaw, Kay-Tee and and Manjer, Jonas and Lindkvist, Bjorn and Overvad, Kim and Bach, Flemming and W. and Tjonneland, Anne and Olsen, Anja and Bergmann, Manuela M. and and Boeing, Heiner and Clavel-Chapelon, Francoise and Lund, Eiliv and and Hallmans, Goran and Middleton, Lefkos and Vineis, Paolo and Riboli, Elio",
    journal = "Annals of Neurology",
    year = "2009",
    volume = "65",
    number = "4",
    pages = "378-385",
    publisher = "Wiley-Liss, Inc.",
    issn = "0364-5134, 1531-8249",
    doi = "10.1002/ana.21653",
    abstract = "Objective: Cigarette smoking has been reported as “probable” risk
factor for Amyotrophic Lateral Sclerosis (ALS), a poorly understood
disease in terms of aetiology. The extensive longitudinal data of the
European Prospective Investigation into Cancer and Nutrition (EPIC) were
used to evaluate age-specific mortality rates from ALS and the role of
cigarette smoking on the risk of dying from ALS.
Methods: A total of 517,890 healthy subjects were included, resulting in
4,591,325 person-years. ALS cases were ascertained through death
certificates. Cox hazard models were built to investigate the role of
smoking on the risk of ALS, using packs/years and smoking duration to
study dose-response.
Results: A total of 118 subjects died from ALS, resulting in a crude
mortality rate of 2.69 per 100,000/year. Current smokers at recruitment
had an almost two-fold increased risk of dying from ALS compared to
never smokers (HR = 1.89, 95% C.I. 1.14-3.14), while former smokers at
the time of enrolment had a 50% increased risk (HR = 1.48, 95% C.I.
0.94-2-32). The number of years spent smoking increased the risk of ALS
(p for trend = 0.002). Those who smoked more than 33 years had more than
a two-fold increased risk of ALS compared with never smokers (HR = 2.16,
95% C.I. 1.33-3.53). Conversely, the number of years since quitting
smoking was associated with a decreased risk of ALS compared with
continuing smoking.
Interpretation: These results strongly support the hypothesis of a role
of cigarette smoking in aetiology of ALS. We hypothesize that this could
occur through lipid peroxidation via formaldehyde exposure. Ann Neurol
2009;65:378-385"
}