Patients With Seizures Face Higher Cardiovascular Risk

TOPLINEPatients with late-onset seizures faced an approximately twofold higher risk for major ischaemic cardiovascular disease or death than control participants, especially within the first 2 years after diagnosis. Prolonged cumulative exposure to enzyme-modulating antiseizure medications was associated with a modestly increased risk for cardiovascular disease.METHODOLOGYResearchers conducted a nationwide study using data from a national insurance claims registry to assess whether patients with late-onset seizures experience a higher risk for major ischaemic cardiovascular events or death than those without seizures.They included 8728 patients aged 50 years or older with a seizure disorder and 17,445 matched control participants without a seizure disorder, with a 2-year washout period (2012-2013) and a 5-year follow-up period (2015-2019); the median age was 67 years for both groups, and 56.4% were men in each group.Antiseizure medications prescribed after diagnosis and continued for more than 6 months were classified as either enzyme-modulating or non-enzyme-modulating antiseizure medications. Cumulative exposure to enzyme-modulating antiseizure medications was defined as the total time on the medication over follow-up.The composite outcome was incident ischaemic cardiovascular disease — including myocardial infarction, transient ischaemic attack, and ischaemic stroke — or death, and risks for these outcomes were compared among patients initiating enzyme-modulating vs non-enzyme-modulating antiseizure medications.TAKEAWAYPatients with a seizure disorder had a significantly higher risk for the composite outcome than control participants (hazard ratio [HR], 2.30), with the strongest effect observed within the first 2 years after diagnosis (HR, 3.69; P < .001 for both).Increasing age was significantly associated with a 7% higher risk for the composite outcome (HR per year, 1.07; P < .001), and women showed a 21% lower risk than men (HR, 0.79; P < .001).Current exposure to enzyme-modulating antiseizure medications was associated with a 20% lower risk for the composite outcome than exposure to non-enzyme-modulating antiseizure medications (HR, 0.80; P = .001), whereas prior cumulative exposure to enzyme-modulating agents was associated with a 41% increased risk (HR per year of exposure, 1.41; P < .001).Enzyme-modulating antiseizure medications were associated with a non-significant increase in the risk for the composite outcome compared with non-enzyme-modulating antiseizure medications.IN PRACTICE"Our analyses suggest that prolonged exposure to EMASMs [enzyme-modulating antiseizure medications] may contribute to cardiovascular risk," the authors wrote.SOURCEThis study was led by Paola Vassallo, UCL Queen Square Institute of Neurology, London, England. It was published online on July 18, 2026, in Epilepsia.LIMITATIONSBecause the study relied on insurance claims data with standardised codes and prescription records, the possibility of residual confounding cannot be ruled out. Data on medication adherence, combination therapy details, and confounding by indication could not be assessed. The requirement for sustained antiseizure medication exposure may have resulted in an underestimation of early cardiovascular events, particularly cardiac conduction disorders.DISCLOSURESThis study did not provide any funding information. Several authors declared receiving grants; unrestricted educational grants; or personal compensation for consulting, serving on advisory boards, and speaking engagements from various pharmaceutical companies.This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.