Cardiovascular morbidity following epilepsy: A nationwide retrospective cohort study in South Korea.

OBJECTIVE

This study evaluated the long-term risk of major cardiovascular diseases (CVDs) in patients with epilepsy using a nationwide cohort, aiming to address critical gaps in population-based evidence on brain-heart interactions.

METHODS

Data from the Korean National Health Insurance Service (2002-2013) were analyzed. For each cardiovascular outcome, an independent matched cohort was constructed, comprising 1740 to 3164 patients with newly diagnosed epilepsy and corresponding 10-fold matched controls. The primary outcomes included six CVDs: hypertension (HTN), ischemic heart disease (IHD), cardiac arrhythmia (CA), heart failure (HF), atherosclerosis (AS), and peripheral artery disease (PAD). Incidence rate ratios (IRRs) and adjusted hazard ratios (aHRs) were calculated using multivariable Cox regression models.

RESULTS

Epilepsy was significantly associated with increased risk of all six CVDs. The highest aHRs were observed for CA (2.02 [95% CI, 1.70-2.39]), IHD (1.71 [95% CI, 1.50-1.95]), and HF (1.64 [95% CI, 1.28-2.10]). Risk was higher in patients aged <60 years and in men. Notably, younger patients showed substantially elevated risks for CA (2.61 [95% CI, 1.99-3.42]) and AS (2.06 [95% CI, 1.47-2.89]). The sex-specific difference was most prominent for HF, with higher aHRs in men (1.86 [95% CI, 1.29-2.67]) than in women (1.49 [95% CI, 1.07-2.09]).

SIGNIFICANCE: Patients with epilepsy have a significantly increased long-term risk of CVD, especially CA, IHD, and HF. Risk is disproportionately elevated in younger individuals and men, suggesting the need for targeted cardiovascular surveillance and prevention in these subgroups.

PLAIN LANGUAGE SUMMARY: People with epilepsy may face a higher risk of heart and blood vessel diseases such as heart attack, irregular heartbeat, and heart failure. This study analyzed national health data from Korea and found that epilepsy patients had more cardiovascular problems than those without epilepsy, especially younger men. These results suggest that doctors should monitor heart health more closely in people living with epilepsy.