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Myocardial infarction after epilepsy onset: A population-based retrospective cohort study
Dulaney A Wilson1, Braxton B Wannamaker2, Angela M Malek1
1Medical University of South Carolina, Department of Public Health Sciences, Charleston, SC, USA.
Epilepsy & Behavior : E&B
|October 7, 2018
Summary
Individuals with epilepsy face a moderately increased risk of myocardial infarction (MI) compared to those with migraine or lower extremity fractures. This highlights the need for comprehensive cardiovascular risk management in epilepsy care.
Area of Science:
- Neurology
- Cardiology
- Public Health
Background:
- Epilepsy shares cardiovascular comorbidities like hypertension and diabetes with myocardial infarction (MI).
- Limited data exist on subsequent cardiovascular disease (CVD) risk in persons with epilepsy (PWE), with inconsistent findings on epilepsy's association with MI.
- A hypothesis proposed a higher risk of MI in adults following epilepsy diagnosis compared to controls.
Purpose of the Study:
- To investigate the association between epilepsy and the risk of subsequent myocardial infarction (MI).
- To compare the risk of MI in persons with epilepsy (PWE) against persons with migraine (PWM) and persons with isolated lower extremity fracture (PWLF).
Main Methods:
- A retrospective cohort study utilized statewide hospital and emergency department data from 2000-2013 in South Carolina.
- Adults without prior MI were analyzed, comparing PWE to PWM and PWLF.
- Cox proportional hazard modeling evaluated the association between epilepsy and subsequent MI.
Main Results:
- Persons with epilepsy (PWE) had a 48% higher hazard of subsequent MI compared to persons with migraine (PWM) (HR=1.48).
- PWE showed a 24% higher hazard of subsequent MI compared to persons with isolated lower extremity fracture (PWLF) (HR=1.24).
- Risk of MI increased with age, comorbidities, male sex, rural residence, and specific cardiovascular risk factors.
Conclusions:
- Persons with epilepsy face a moderately elevated risk of subsequent myocardial infarction.
- Further investigation into the epilepsy-MI association is warranted.
- Clinical management for PWE should incorporate evaluation and management of MI risk factors.
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