Epilepsy-Heart Syndrome: CVD events increase after epileptic seizures on a long and short-term basis

The risks of cardiovascular events (CVEs) in people with epilepsy(PWE) are not well understood.

A study was done to establish the short- and long-term burden of CVEs in PWE.

Electronic health records from a global federated health research network (TriNetX) were used to establish a cohort of PWE. Primary outcomes were: i) the proportion of people experiencing a composite outcome of cardiac arrest, acute heart failure (HF), acute coronary syndrome(ACS), atrial fibrillation(AF), severe ventricular arrhythmia or all-cause death within 30 days of seizure; and ii) the 5-year risk for a composite outcome of ischemic heart diseases, stroke, hospitalization, or all-cause death in the PWE experiencing early CVEs. Cox-regression analyses with propensity score matching was used to produce hazard ratios (HRs) and 95% confidence intervals (CI).

Results

In 271,172 PWE (mean age 50±20 years; 52% females), the 30-day risk of CVEs following seizure was: 8.7% for the composite outcome, 0.9% for cardiac arrest, 0.8% for HF, 1.2% for ACS, 4.1% for AF, 0.7% for severe ventricular arrhythmias, and 1.6% for all-cause death. For the 15,120 PWE experiencing CVEs within 30 days of seizure, the 5-year adjusted risks for all composite outcomes measured were significantly increased (overall HR: 2.44, 95%CI 2.37–2.51), ischemic heart diseases HR 3.23 (95%CI 3.10–3.36), stroke HR 1.56 (95%CI 1.48–1.64), hospitalization HR 2.03 (95%CI 1.97–2.10), and all-cause death HR 2.75 (95%CI 2.61–2.89).

The large proportions of PWE with active disease that experience CVEs and the poor long-term outcome associated suggest the existence of an ‘epilepsy-heart syndrome’.

Reference:

Azmil H. Abdul-Rahim, Gregory Y.H. Lip. Epilepsy-Heart Syndrome: Incidence and Clinical Outcomes of Cardiac Complications in Patients with Epilepsy. Current Problems in Cardiology, 2023, 101868, ISSN 0146-2806. https://doi.org/10.1016/j.cpcardiol.2023.101868.

(https://www.sciencedirect.com/science/article/pii/S0146280623002852)