Epilepsy research · 2026
Long-term risk of major adverse cardiovascular events in patients with epilepsy: Roles of childhood onset and antiseizure medications.
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Zhang Guifen, Lin Junjie, Xu Xiaolin, Li Wenyuan, Wang Baohui, Li Xiaoyu, Guo Yi
Аннотация
PURPOSE: Evidence regarding long-term major adverse cardiovascular events (MACEs) risk in patients with epilepsy (PWE) remains limited. This study investigates the longitudinal epilepsy-MACE association, with specific focus on the roles of childhood-onset epilepsy and antiseizure medications (ASMs) exposure.
METHODS: This population-based cohort study included 459,534 UK Biobank participants recruited from 2006 to 2010. MACE risk in epilepsy was evaluated using Kaplan-Meier survival curves and multivariable Cox proportional hazards models; stratified analyses by age at onset and ASM exposure were performed, with sensitivity analyses to verify robustness.
RESULTS: Among 459,534 individuals, 4401 (0.96%) had epilepsy and 455,133 (99.04%) did not. Compared to those without epilepsy, PWE were associated with significantly higher long-term risks of MACE: HR 1.43 [95% CI, 1.34-1.53], including coronary heart disease (CHD) (HR 1.32 [95% CI, 1.20-1.44]), atrial fibrillation (AF) (HR 1.44 [95% CI, 1.30-1.60]), heart failure (HF) (HR 1.44 [95% CI, 1.24-1.67]), stroke (HR 2.03 [95% CI, 1.77-2.33]), and transient ischemic attack (TIA) (HR 1.55 [95% CI, 1.23-1.95]). Sensitivity analyses corroborated these findings. Notably, the risk of MACE associated with childhood-onset epilepsy was not significantly higher than that with adult-onset epilepsy. Furthermore, the use of ASMs - including both sodium channel blockers (SCBs) and enzyme-inducing ASMs (EIASMs) - did not show an increased risk of MACE in PWE compared to those not taking ASMs.
CONCLUSIONS: Epilepsy is associated with elevated long-term MACE risk.Crucially, childhood-onset epilepsy confers no higher cardiovascular risk than adult-onset epilepsy, and ASMs (including SCBs and EIASMs) collectively do not elevate MACE risk in PWE These findings highlight routine cardiovascular monitoring in PWE.
METHODS: This population-based cohort study included 459,534 UK Biobank participants recruited from 2006 to 2010. MACE risk in epilepsy was evaluated using Kaplan-Meier survival curves and multivariable Cox proportional hazards models; stratified analyses by age at onset and ASM exposure were performed, with sensitivity analyses to verify robustness.
RESULTS: Among 459,534 individuals, 4401 (0.96%) had epilepsy and 455,133 (99.04%) did not. Compared to those without epilepsy, PWE were associated with significantly higher long-term risks of MACE: HR 1.43 [95% CI, 1.34-1.53], including coronary heart disease (CHD) (HR 1.32 [95% CI, 1.20-1.44]), atrial fibrillation (AF) (HR 1.44 [95% CI, 1.30-1.60]), heart failure (HF) (HR 1.44 [95% CI, 1.24-1.67]), stroke (HR 2.03 [95% CI, 1.77-2.33]), and transient ischemic attack (TIA) (HR 1.55 [95% CI, 1.23-1.95]). Sensitivity analyses corroborated these findings. Notably, the risk of MACE associated with childhood-onset epilepsy was not significantly higher than that with adult-onset epilepsy. Furthermore, the use of ASMs - including both sodium channel blockers (SCBs) and enzyme-inducing ASMs (EIASMs) - did not show an increased risk of MACE in PWE compared to those not taking ASMs.
CONCLUSIONS: Epilepsy is associated with elevated long-term MACE risk.Crucially, childhood-onset epilepsy confers no higher cardiovascular risk than adult-onset epilepsy, and ASMs (including SCBs and EIASMs) collectively do not elevate MACE risk in PWE These findings highlight routine cardiovascular monitoring in PWE.