Cardiovascular and bone health comorbidities in epilepsy

Epilepsy increases risk of cardiovascular morbidity and mortality, and growing evidence suggests broader systemic effects, including on bone health. This review examines the evolving concepts of the "epilepsy-heart syndrome' and the impact that both epilepsy and antiseizure medications (ASMs) have on cardiovascular and both health, highlighting why timely recognition is clinically and scientifically imperative.

Epilepsy promotes myocardial injury through catecholamine surges, hypoxemia, and ischemia, resulting in arrhythmias, diastolic dysfunction, and accelerated atherosclerosis. Conversely, cardiovascular disorders and metabolic dysregulation predispose to epilepsy, reinforcing a bidirectional relationship. Enzyme-inducing ASMs increase lipid levels, attenuate statin efficacy, and increase risks of long-term cardiovascular disease. Both enzyme-inducing and noninducing ASMs contribute to reduced bone mineral density and potentially to increased fracture risk via altered vitamin D metabolism and hormonal effects.

Epilepsy is a multisystem disorder that encompasses cardiovascular disease and skeletal fragility. Although formal guidelines are currently lacking, clinicians should consider integrating cardiovascular screening, rational ASM selection, and proactive bone-health surveillance into routine epilepsy management. Research should focus on longitudinal, mechanistic, and interventional studies to improve cardiovascular and bone health and to validate emerging screening and management guidelines to improve overall health in epilepsy.