medwireNews: People with epilepsy have poorer cardiovascular health than those without the disorder, with increased incidences of all-cause death, cardiovascular death, ischemic stroke, and cardiac arrest, research shows.
Among people with epilepsy, the incidence rate of each of these events over a mean follow-up of 1.9 years was twofold higher than that for controls, while the incidence of sustained ventricular tachycardia or fibrillation (VT/VF) and heart failure was increased by 10% and 26%, respectively.
“This work does not imply causation, but generates a number of hypotheses that warrant attention, including the possibility of shared mechanisms between cardiac and brain health,” write Gregory Lip (Liverpool Centre for Cardiovascular Science, UK) and colleagues in the European Journal of Neurology.
They add: “As cardiovascular disease contributes a significant proportion of morbidity and mortality in this population, improving cardiovascular health is an attractive target to reduce premature deaths in [patients with epilepsy].”
The team mined the French Hospital National Database for data from 682,349 patients with epilepsy older than 18 years of age, who were hospitalized for any cause, and the same number of control patients matched for age, sex, and year of hospitalization. The mean age of the participants was 61.4 years and 52.8% were men.
Baseline data indicated that the people with epilepsy were significantly more likely than controls to have cardiovascular risk factors such as hypertension (37.7 vs 15.4%), diabetes (15.2 vs 6.4%), and chronic kidney disease (5.4 vs 1.3%), in addition to unhealthy lifestyle factors such as smoking (11.0 vs 2.7%), poor nutrition (17.7 vs 3.4%), and obesity (10.6 vs 4.3%).
"These factors are likely contributory to the high incident rates of cardiovascular outcomes,” say Lip et al.
Indeed, at baseline a greater proportion of individuals with epilepsy than without had cardiovascular comorbidities including heart failure, myocardial infarction, sustained cardiac arrhythmia, or ischemic stroke, at 26.4% vs 9.5%. The epilepsy group was also more likely to have other types of comorbidities including lung pathologies, cancer, and inflammatory diseases.
Moreover, longitudinal analysis indicated an increased incidence of these cardiovascular events as well as all-cause or cardiovascular death among people with epilepsy over follow-up, at a rate of 31.0%, compared with 17.0% among those without epilepsy.
When each of the outcomes was considered individually, incidence rates per year were higher among those with than without epilepsy for all-cause death (11.31 vs 4.20%) cardiovascular death (2.02 vs 0.94%), heart failure (4.75 vs 3.76%), ischemic stroke (1.91 vs 0.91%), VT/VF (0.19 vs 0.17%), and cardiac arrest (0.66 vs 0.31%). This corresponded to hazard ratios (HRs) among people with versus without epilepsy of 2.50, 1.79, 0.97, 1.59, 0.83, and 1.73, after accounting for the competing effects of all-cause death.
However, the researchers noted the opposite trend for myocardial infarction and atrial fibrillation, for which the incidence rates per year were lower among patients with than without epilepsy, at 0.66% versus 0.77% and 2.32% versus 3.10%, respectively, corresponding to HRs of 0.63 and 0.58.
The findings were the same even when excluding patients with a prior history of ischemic stroke or intracranial hemorrhage.
“To our knowledge, this is the largest study of comorbidity and incident cardiovascular outcomes in [patients with epilepsy],” write Lip et al, adding that their results reflect similar outcomes from other clinical studies in such patients.
They suggest that the unexpected lower incidence of myocardial infarction and atrial fibrillation in participants with epilepsy could have been due to unknown medication and procedural factors that may modify the subsequent risk, a lack of knowledge of the details of cardiovascular disease deaths, or bias resulting from not matching comorbidities between people with epilepsy and controls.
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