Epilepsy and incident cardiovascular disease: A prospective UK Biobank cohort study

As a neurological disorder, epileptic seizures have been documented to correlate with structural and functional cardiac alterations in prior studies. However, the long-term risk association between epilepsy and cardiovascular diseases (CVDs) remains incompletely elucidated.

This prospective population-based cohort study utilized individual-level data from the UK Biobank. The primary composite endpoint comprised incident CVDs, including ischemic heart disease (IHD), heart failure (HF), atrial fibrillation (AF), stroke, and cardiovascular death. Cox proportional hazards regression models with covariate adjustments, complemented by Fine-Gray competing risk analyses, were employed to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for assessing epilepsy-CVD associations.

A total of 448,487 participants, including 7,220 patients with epilepsy, were included in the analyses. Over a median follow-up of 13.4 years (IQR: 12.5-14.1; range: 3.0-16.2 years), 2,097 (29.0%) and 64,341 (14.6%) participants experienced CVDs in the epilepsy and non-epilepsy cohorts, respectively. Epilepsy was associated with higher risks of overall CVDs (HR: 1.97, 95% CI: 1.88-2.06) and specific cardiovascular outcomes including IHD (HR: 1.63, 95% CI: 1.53-1.74), HF (HR: 1.89, 95% CI: 1.72-2.09), AF (HR: 1.78, 95% CI: 1.65-1.91), stroke (HR: 4.32, 95% CI: 4.01-4.64), and cardiovascular mortality (HR: 2.55, 95% CI: 2.26-2.88), after adjustment for available common variant-based genetic predisposition scores. Furthermore, patients with status epilepticus exhibited a significantly higher CVDs risk compared to those with epilepsy alone (HR: 1.70, 95% CI: 1.43-2.02).

Epilepsy was associated with higher risks of incident CVDs, including IHD, HF, AF, stroke, and cardiovascular mortality. These findings suggest that patients with epilepsy may represent a population at elevated cardiovascular risk, although causal inference cannot be established.