Is restless legs syndrome associated with cardiovascular disease?

h f d O p 1 c h Restless legs syndrome is a common condition characterized by a strong urge to move the limbs that is usually worse during the evening and nighttime hours, that is worsened by rest, and that improves with activity. However, the prevalence has varied in different studies, primarily depending on the criteria chosen to define this disorder. Prior studies using the International Restless Legs Syndrome Study Group criteria have placed the prevalence between 3.9% and 4.3%. Restless legs syndrome is associated with diverse adverse consequences. Health-related quality of life is reduced in those with restless legs syndrome and is lower in those with more severe disease. Restless legs syndrome also can lead to an increased prevalence of insomnia, depression, and anxiety. Several large epidemiologic studies have suggested a causal association between restless legs syndrome and cardiovascular disorders and hypertension after controlling for confounders such as age, witnessed apneas, and smoking. Furthermore, a recent study using prospectively obtained data from the Nurses’ Health Study found an increased risk of incident nonfatal myocardial infarction in those with a history of restless legs syndrome for 3 years or more (hazard ratio, 1.80; 95% confidence interval [CI], 1.07-3.01). The ncreased risk of coronary heart disease persisted after adustment for blood pressure, diabetes duration, and use of iabetes medications. However, not all studies have oberved an association between restless legs syndrome and ardiovascular disease. In this issue of the Journal, additional evidence from 2 tudies is presented relating to the putative association beween restless legs syndrome and hypertension and cardioascular disease. In the first study by Winter et al, 22,786 ale participants of the US Physicians’ Health Studies I and I were studied. The mean age of the participants was 67.8 ears. Restless legs syndrome was present in 7.5% of the articipants, and the prevalence increased significantly with ge. Furthermore, the odds of restless legs syndrome were