Cardiovascular Disease Burden, Mortality, and Sudden Death Risk in Epilepsy: A UK Biobank Study

Area of Science:

• Cardiology
• Neurology
• Epidemiology

Background:

• Sudden death is a primary cause of mortality in individuals with medically refractory epilepsy.
• The mortality risk and cardiovascular disease (CVD) burden in middle-aged persons with epilepsy (PWE) remain under-investigated.

Purpose of the Study:

• To investigate the prevalence of CVD and assess mortality risks, including all-cause and sudden death, in middle-aged PWE compared to a non-epilepsy cohort.

Main Methods:

• Utilized UK Biobank data for 7220 PWE and 494,676 controls, with a mean follow-up of 12.30 years.
• Employed Cox proportional hazards regression to analyze all-cause and sudden death risks.
• Determined CVD prevalence using validated diagnostic codes, excluding participants with prior stroke history.

Main Results:

• PWE exhibited higher prevalence of hypertension, coronary artery disease, heart failure, valvular heart disease, and congenital heart disease.
• Arrhythmias (atrial fibrillation/flutter, bradyarrhythmias, conduction defects, ventricular arrhythmias) and cardiac implantable electronic devices were more common in PWE.
• PWE faced significantly higher adjusted all-cause mortality (HR 3.9) and sudden death-specific mortality (HR 6.65), dying approximately 2 years younger.

Conclusions:

• Middle-aged PWE experience elevated all-cause and sudden death mortality, coupled with a greater burden of CVD, including arrhythmias and heart failure.
• Further research is essential to understand the mechanisms behind mortality in PWE and to develop targeted preventative therapies and prognostic biomarkers.