Older Patients of epilepsy more likely to develop cardiovascular events: JAMA

A new study published in the recent edition of Journal of American Medical Association suggests that when providing enzyme-inducing antiseizure medications (EIASMs) to elderly patients who have epilepsy, doctors should use caution if there are additional cardiovascular risk factors present.

In their lifetime, one in 10 persons will experience at least one epileptic episode. Although epilepsy frequently strikes younger people, adults 60 years of age and beyond account for the majority of persons with epilepsy (PWE), both new onset and long-standing. There is a robust cross-sectional correlation between cardiovascular disease (CVD) and epilepsy. Also, a number of studies have demonstrated that there is a significant risk of developing cerebrovascular disease even in individuals whose epilepsy is not caused by it. Thereby, Jimmy Li and his team conducted this study to investigate the probabilities of new-onset cardiovascular events (CVEs) in patients with and without epilepsy during a 6-year period. Also, the mediation effects of EIASM usage and conventional cardiovascular risk factors (CVRFs) on this connection was investigated, with the goal of determining respective contribution of each factor to CVD risk in epilepsy.

This prospective cohort research utilized the whole cohort of the Canadian Longitudinal research on Ageing (CLSA) with a 6-year follow-up. The CLSA was a continuous, nationwide research project that recruited a total of 51,338 Canadian individuals between the ages of 45 and 85 at baseline. 30,097 people who reside close to one of the 11 data gathering centers make up the comprehensive cohort. A voluntary 45% of people took part in the CLSA. The people who had no prior history of CVEs at baseline were not included in the comprehensive cohort. There were no further exclusion standards used and 86% percent of participants finished the follow-up.

Of the 30,097 participants included in the comprehensive cohort, 27,230 had a history of epilepsy, 431 of whom were included in the total. Epilepsy patients had a 2.20 adjusted risk ratio for new-onset CVEs. Each of the following factors that mediated a different proportion of the effect of epilepsy on new-onset CVEs were;

• strong EIASM usage (24.6%)
• weak EIASM use (4.0%)
• Framingham score (1.4%)
• PASE score (3.3%)
• waist to hip ratio (1.6%).

Overall, the findings of this study found a correlation between epilepsy and newly diagnosed CVEs.

Source:

Li, J., Shlobin, N. A., Thijs, R. D., Sylvestre, M.-P., Josephson, C. B., Deacon, C., & Keezer, M. R. (2024). Antiseizure Medications and Cardiovascular Events in Older People With Epilepsy. In JAMA Neurology. American Medical Association (AMA). https://doi.org/10.1001/jamaneurol.2024.3210