Narcolepsy Is Associated With Subclinical Cardiovascular Disease as Early as Childhood: A Big Data Analysis

Narcolepsy is linked to adverse cardiovascular disease (CVD) outcomes, but few studies have examined its associations with subclinical CVD, including in children. We assessed the relationship between narcolepsy and subclinical CVD outcomes, including hypertension, hyperlipidemia, diabetes, and nonalcoholic fatty liver disease/nonalcoholic steatohepatitis.

We conducted a retrospective cohort study using MarketScan Commercial and Medicare Supplemental databases from January 1, 2005 to December 31, 2021. Patients included N=22 293 diagnosed with narcolepsy (NT1 and NT2) and N=63 709 propensity-score-matched without. Patients with narcolepsy were identified as those with ≥2 outpatient insurance claims for narcolepsy (type 1 or type 2) within a 1-year interval with 1 claim being nondiagnostic. Main outcomes were diagnosis of hypertension, hyperlipidemia, diabetes, and nonalcoholic fatty liver disease/nonalcoholic steatohepatitis following index date, as well as a composite measure for CVD and major adverse cardiovascular events. Compared with propensity-score-matched patients without narcolepsy, patients with narcolepsy had an increased risk for hypertension (hazard ratio [HR], 1.40 [95% CI, 1.34-1.47]), hyperlipidemia (HR, 1.41 [95% CI, 1.35-1.47]), diabetes (HR, 1.50 [95% CI, 1.38-1.64), nonalcoholic fatty liver disease/nonalcoholic steatohepatitis (HR, 1.48 [95% CI, 1.28-1.73]), CVD composite (HR,1.61 [95% CI, 1.35-1.47]), and major adverse cardiovascular events (HR,1.69 [95% CI, 1.43-2.00]). Results remained significant following adjustment for narcolepsy medications including stimulants, wake-promoting agents, and oxybates. Results stratified by age groups showed similar findings, including heightened risk for those <25 years old.

Narcolepsy is associated with greater risk of subclinical CVD even in patients as early as childhood. Detection of these outcomes early in the course of narcolepsy could help reduce the burden of adverse cardiovascular events later in life.