ADULTS with a lifetime history of epilepsy are approximately twice as likely to develop new cardiovascular events (CVEs), such as strokes, transient ischemic attacks (TIAs), and myocardial infarctions (MIs), and this is partly attributable to the use of enzyme-inducing antiseizure medications (EIASMs).
Researchers aimed to examine whether older adults with epilepsy face a higher risk of CVEs than those without epilepsy and to evaluate the contribution of EIASMs to this risk. The study used data from the Canadian Longitudinal Study on Aging (CLSA), a large national cohort study that followed participants aged 45 to 85 over six years. Researchers included individuals who had no history of CVEs at baseline and excluded those with previous incidents of stroke, TIA, or MI. Logistic models were applied to assess the likelihood of developing new CVEs, while mediation analyses were conducted to quantify the effects of factors such as EIASM use, cardiovascular risk scores, and lifestyle measures.
The results showed that adults with epilepsy had an adjusted odds ratio of 2.20 for developing new CVEs (95% CI: 1.48-3.27), meaning they were more than twice as likely as their non-epileptic counterparts to experience these events. The use of strong EIASMs explained 24.6% of this increased risk (95% CI, 6.5%-54.6%), while weak EIASMs accounted for 4.0% (95% CI, 0.8%-11.0%). Other cardiovascular risk factors, such as the Framingham score, physical activity levels, and waist-to-hip ratio, contributed marginally to the increased risk (1.4%, 3.3%, and 1.6%, respectively).
In conclusion, epilepsy in older adults is associated with a significantly higher risk of cardiovascular events, with a notable proportion of this risk linked to the use of EIASMs. Clinicians should carefully consider the potential cardiovascular implications when prescribing EIASMs, particularly in patients with additional cardiovascular risk factors. Future research should explore alternative seizure management strategies that minimize cardiovascular risks in older populations.
Katrina Thornber, EMJ
Reference
Li J et al. Antiseizure medications and cardiovascular events in older people with epilepsy. JAMA Neurol.2024;DOI:10.1001/jamaneurol.2024.3210.
