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

Ravi A. Shah,C. Anwar A. Chahal, Shaheryar Ranjha,Ghaith Sharaf Dabbagh, Babken Asatryan,Ivan Limongelli, Mohammed Khanji,Fabrizio Ricci, Federica De Paoli,Susanna Zucca, Martin Tristani-Firouzi,Erik K. St. Louis, Elson L. So,Virend K. Somers

CANADIAN JOURNAL OF CARDIOLOGY(2024)

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摘要
Background: Sudden death is the leading cause of mortality in medically refractory epilepsy. Middle-aged persons with epilepsy (PWE) are under investigated regarding their mortality risk and burden of cardiovascular disease (CVD). Methods: Using UK Biobank, we identi fi ed 7786 (1.6%) participants with diagnoses of epilepsy and 6,171,803 person -years of follow-up (mean 12.30 years, standard deviation 1.74); 566 patients with previous histories of stroke were excluded. The 7220 PWE comprised the study cohort with the remaining 494,676 without epilepsy as the comparator group. Prevalence of CVD was determined using validated diagnostic codes. Cox proportional hazards regression was used to assess all -cause mortality and sudden death risk. Results: Hypertension, coronary artery disease, heart failure, valvular heart disease, and congenital heart disease were more prevalent in PWE. Arrhythmias including atrial fi brillation/ fl utter (12.2% vs 6.9%; P < 0.01), bradyarrhythmias (7.7% vs 3.5%; P < 0.01), conduction defects (6.1% vs 2.6%; P < 0.01), and ventricular arrhythmias (2.3% vs 1.0%; P < 0.01), as well as cardiac implantable electric devices (4.6% vs 2.0%; P < 0.01) were more prevalent in PWE. PWE had higher adjusted all -cause mortality (hazard ratio [HR], 3.9; 95% con fi dence interval [CI], 3.01-3.39), and sudden death -speci fi c mortality (HR, 6.65; 95% CI, 4.53-9.77); and were almost 2 years younger at death (68.1 vs 69.8; P < 0.001). Conclusions: Middle-aged PWE have increased all -cause and sudden death -speci fi c mortality and higher burden of CVD including arrhythmias and heart failure. Further work is required to elucidate mechanisms underlying all -cause mortality and sudden death risk in PWE of middle age, to identify prognostic biomarkers and develop preventative therapies in PWE.
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