ImportanceHow epilepsy may promote cardiovascular disease remains poorly understood.ObjectiveTo estimate the odds of new-onset cardiovascular events (CVEs) over 6 years in older people with vs without epilepsy, exploring how enzyme-inducing antiseizure medications (EIASMs) and traditional cardiovascular risk factors mediate these odds.Design, Setting, and ParticipantsThis was a prospective cohort study using the comprehensive cohort of the Canadian Longitudinal Study on Aging (CLSA), with 6 years of follow-up (2015-2021, analysis performed in December 2023). The CLSA is an ongoing, national study of 51 338 adults aged 45 to 85 years at baseline who are recruited in Canada. The comprehensive cohort includes 30 097 individuals living near 1 of 11 data collection centers. Participation in the CLSA was voluntary; participation rate was 45%. Among those in the comprehensive cohort, individuals reporting no previous history of CVEs (ie, 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.ExposureLifetime history of epilepsy.Main Outcomes and MeasuresThe primary outcome was new-onset CVEs over 6 years. Secondary outcomes were new-onset strokes, TIAs, and MIs. Logistic models were fitted for these outcomes as a function of epilepsy, age, sex, household income, and education level. Mediation analyses were conducted for strong EIASM use, weak EIASM use, Framingham score, Physical Activity Scale for the Elderly (PASE) score, and waist to hip ratio.ResultsAmong 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. New-onset CVEs were more likely in epilepsy, with an adjusted odds ratio of 2.20 (95% CI, 1.48-3.27). The proportion 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%).Conclusions and RelevanceResults of this cohort study reveal that epilepsy was associated with new-onset CVEs. Nearly one-third of this association can be explained by EIASMs. These findings should be considered when choosing an antiseizure medication for a person at risk for cardiovascular disease.

中文翻译：

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老年癫痫患者的抗癫痫药物和心血管事件


重要性癫痫如何促进心血管疾病仍然知之甚少。目的估计老年人与无癫痫患者 6 年内新发心血管事件 （CVE） 的几率，探讨酶诱导抗癫痫药物 （EIASM） 和传统心血管危险因素如何介导这些几率。设计、设置和参与者这是一项前瞻性队列研究，使用加拿大老龄化纵向研究 （CLSA） 的综合队列，进行了 6 年的随访（2015-2021 年，2023 年 12 月进行的分析）。CLSA 是一项正在进行的全国性研究，对象为在加拿大招募的 51 338 名基线年龄在 45 至 85 岁之间的成年人。综合队列包括 30 097 人，居住在 11 个数据收集中心中的 1 个附近。参加 CLSA 是自愿的;参与率为 45%。在综合队列中，排除了基线时无 CVE 病史 （即卒中、短暂性脑缺血发作 [TIA] 或心肌梗死 [MI]）的个体。未应用其他排除标准。共有 86% 的参与者完成了随访。暴露癫痫终生病史。主要结局和指标主要结局是 6 年内新发的 CVE。次要结局是新发卒中、TIA 和 MIs。根据癫痫、年龄、性别、家庭收入和教育水平对这些结局进行 Logistic 模型拟合。对 EIASM 使用率高、 EIASM 使用率弱、 Framingham 评分、老年人身体活动量表 （PASE） 评分和腰臀比进行中介分析。结果在综合队列的 30 097 例个体中，共有 27 230 例 （平均 [SD] 年龄，62.3 [10.1] 岁;14 268 例女性 [52.4%]），其中 431 例有终生癫痫病史。新发 CVE 在癫痫中的可能性更大，校正比值比为 2.20 （95% CI，1.48-3.27）。癫痫对新发 CVE 影响的比例由以下每个变量介导：强 EIASM 使用，24.6%（95% CI，6.5%-54.6%），弱 EIASM 使用，4.0%（95% CI，0.8%-11.0%），Framingham 评分，1.4%（95% CI，-1.6% 至 4.5%），PASE 评分，3.3%（95% CI，1.4%-6.8%），腰臀比， 1.6% （95% CI，0.4%-3.7%）。结论和相关性该队列研究的结果显示，癫痫与新发 CVE 相关。这种关联中近三分之一可以用 EIASM 来解释。在为有心血管疾病风险的人选择抗癫痫药物时，应考虑这些发现。