Abstracts

Rationale: Beyond seizures, common comorbidities of epilepsy impact health and quality of life.  Certain prevalent comorbid conditions in PWE (people with epilepsy) such as hypertension, hyperlipidemia, and diabetes are associated with myocardial infarction (MI). However, there is a gap in knowledge regarding the development of subsequent cardiovascular disease in PWE, and findings have been inconsistent for the few studies investigating the association betweenepilepsy and subsequent risk of MI.  The incidence of MI and associated risk factors following epilepsy was examined in a large statewide population over a 14-year period. Methods: This retrospective cohort study used statewide hospital discharge and emergency department (ED) encounter data from 2000-2013.  The dataset was limited to individuals aged >18 years at the onset of epilepsy, or the first clinical encounter for controls, without prior MI. The case cohort was PWE while two control cohorts, as used in our prior studies, were: 1) people with migraine (PWM), a neurological condition with characteristics similar to epilepsy, and 2) people with isolated fracture of the lower extremity fracture (PWLF) without history of epilepsy or seizure disorders, whose risk profile presumed to approximate the background risk of the general population. Subsequent MI was defined as a diagnosis of MI after the onset of epilepsy for cases, or after the first clinical encounter for controls. The association of epilepsy, migraine or lower extremity fracture with subsequent MI was evaluated with Cox proportional hazard modeling methods. Results: Of 45,305 PWE, 85,294 PWM and 40,880 PWLF, 2.5%, 0.7% and 1.3% were identified with a subsequent MI, respectively. PWE were significantly more likely to be black (33.7%, 28.5% and 28.0%, respectively), covered by Medicaid (21.7%, 17.2% and 12.7%, respectively), and reside in a rural or low income area compared with PWM and PWLF.  Specific cardiovascular disease risk factors (hypertension, hyperlipidemia, diabetes, tobacco use, and peripheral vascular disorder) were more prevalent in PWE than PWM and PWLF. After adjustment, the hazard of subsequent MI in PWE was 63% higher than in PWM (HR=1.63; 95% CI=1.46-1.82) and 20% higher than in PWLF (HR=1.23; 95% CI=1.11-2.37). Further, the hazard of MI increased with increasing age and number of additional comorbidities, and was higher in males, those living in rural or low income areas, and those with specific cardiovascular risk factors. Conclusions: The risk of MI is significantly elevated in PWE compared with controls independent of other comorbid conditions and demographic characteristics. While further investigation of underlying lifestyle and clinical conditions that contribute to the increased risk of MI as well as potential interventions is needed, including a consideration of evaluation and management of risk factors for MI in clinical care is warranted to fulfill the goal of living well with epilepsy. Funding: None