Older adults with a lifetime history of epilepsy are approximately twice as likely to experience new cardiovascular events, with nearly one-third of this increased risk linked to the use of enzyme-inducing antiseizure medications, according to a recent study.

In the cohort study, published in JAMA Neurology, investigators examined the association between epilepsy and cardiovascular events (CVE) in older adults, focusing on the impact of enzyme-inducing antiseizure medications (EIASM). Utilizing data from the Canadian Longitudinal Study on Aging, they analyzed a cohort of 27,230 participants, among whom epilepsy was reported in 431 participants. 

The investigators found that the participants with epilepsy were more likely to report new-onset CVEs, including strokes and myocardial infarctions, over a 6-year follow-up period compared with the participants without epilepsy. During this period, 1,260 participants, representing 5.5% of the cohort, reported new CVEs, comprising 43 participants (11.9%) with epilepsy and 1,217 participants (5.4%) without the condition.

The participants with epilepsy had an adjusted odds ratio of 2.20 (95% confidence interval [CI] = 1.48–3.27) for the occurrence of new CVEs compared with those without epilepsy. The effect of epilepsy on new CVEs was mediated by several factors: strong EIASM use accounted for 24.6% of the effect (95% CI = 6.5%–54.6%), while weak EIASM use contributed 4.0% (95% CI = 0.8%–11.0%). Additionally, the Physical Activity Scale for the Elderly score mediated 3.3% (95% CI = 1.4%–6.8%), and the waist to hip ratio accounted for 1.6% (95% CI = 0.4%–3.7%). The Framingham risk score mediated 1.4% (95% CI = −1.6% to 4.5%) of the association.

The investigators found that 86% of the participants completed the 6-year follow-up. The findings indicated that nearly one-third of the increased risk for CVEs could be attributed to the use of EIASMs, suggesting that these medications may play a role in the cardiovascular health of older adults with epilepsy.

Full disclosures can be found in the published study.