The primary objective was to approximate the odds of new-onset cardiovascular events (CVEs) over 6 years in older individuals with epilepsy versus individuals without epilepsy and to explore how EIASMs and traditional cardiovascular risk factors influence these odds.
For this prospective cohort study, researchers utilized data from the comprehensive cohort of the Canadian Longitudinal Study on Aging (CLSA), with 6 years of follow-up. CLSA, an ongoing national study of 51,338 adults aged 45 to 85 years at baseline, includes 30,097 individuals living near one of 11 data-collection centers.
The authors wrote, “Participation in the CLSA was voluntary; participation rate was 45%. Among those in the comprehensive cohort, individuals reporting no previous history of CVEs (i.e., stroke, transient ischemic attack [TIA], or myocardial infarction [MI]) at baseline were excluded. No other exclusion criteria were applied. A total of 86% of participants completed follow-up.”
The primary outcome was new-onset CVEs over 6 years, and the secondary outcomes were new-onset strokes, TIAs, and MIs. Logistic models were used to analyze these outcomes based on epilepsy, age, gender, household income, and education level. Mediation analyses were performed for strong and weak EIASM use, Framingham score, Physical Activity Scale for the Elderly (PASE) score, and waist-to-hip ratio.
Among the 30,097 individuals in the comprehensive cohort, a total of 27,230 individuals (mean [SD] age, 62.3 [10.1] years; 14,268 female [52.4%]) were included, 431 with a lifetime history of epilepsy.
The results indicated that new-onset CVEs were more likely to occur in those with epilepsy, with an adjusted odds ratio of 2.20 (95% CI, 1.48-3.27). The percentage of the effect of epilepsy on new-onset CVEs was mediated as follows by each of the following variables: “strong EIASM use, 24.6% (95% CI, 6.5%-54.6%), weak EIASM use, 4.0% (95% CI, 0.8%-11.0%), Framingham score, 1.4% (95% CI, -1.6% to 4.5%), PASE score, 3.3% (95% CI, 1.4%-6.8%), and waist to hip ratio, 1.6% (95% CI, 0.4%-3.7%).”
Based on their findings, the authors concluded that adults with a lifetime history of epilepsy were about two times more likely to report the incidence of new CVEs, including strokes, transient ischemic attacks, and myocardial infarctions, over 6 years, and an estimated one-third of this association may be due to the use of EIASMs.
The authors wrote, “Results suggest that clinicians should be careful when prescribing EIASMs to older adults with epilepsy, especially in the presence of other cardiovascular risk factors.”
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