Earlier age of onset in multiple system atrophy with smoking and heavy alcohol use

Objective: To determine whether smoking or alcohol use impacts the age of onset and disease duration in multiple system atrophy (MSA). Methods: All patients diagnosed with MSA at Mayo Clinic, Rochester between 1998 and 2012 completed standardized questionnaires surveying smoking and alcohol use at the time of presentation. Results: Of 551 patients with smoking and alcohol use data, 281 were past or present smokers with age of onset of 60.76 years compared to 62.97 years in controls (p = 0.0144). Age of onset in the 87 heavy alcohol users was 56.87 years compared to 62.97 years in controls (p = 0.0133). There was no difference in disease duration for smokers (p = 0.2758) or heavy alcohol users (p = 0.4820) compared to controls. Conclusion: Our findings show that smoking history and/or heavy alcohol use is associated with younger age of onset in MSA but do not influence survival.