University of Michigan, Department of Neurology, Ann Arbor, MI 48109, United States; University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor, MI 48109, United States.
University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor, MI 48109, United States; Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Insitute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland; Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI 48109, United States.
Epilepsy Behav. 2021 Apr;117:107878. doi: 10.1016/j.yebeh.2021.107878. Epub 2021 Mar 6.
To evaluate whether cardiovascular risk, risk awareness, and guideline concordant treatment differ in individuals with versus without epilepsy.
This was a retrospective cross-sectional study using the National Health and Nutrition Examination Survey. We included participants ≥18 years for 2013-2018. We classified participants as having epilepsy if reporting ≥1 medication treating seizures. We calculated 10-year atherosclerotic cardiovascular disease (ASCVD) risk using the revised pooled cohort equation. We compared unadjusted and adjusted risk for participants with versus without epilepsy. We then assessed hypertension and diabetes disease awareness and control, plus statin guideline-concordance. We assessed mediators for both ASCVD risk and cardiovascular disease awareness.
Of 17,961 participants, 154 (0.9%) had epilepsy. Participants with epilepsy reported poorer diet (p = 0.03), fewer minutes of moderate-vigorous activity per day (p < 0.01), and increased frequency of cardiovascular conditions (e.g. coronary heart disease, myocardial infarction, stroke). There was no difference in control of individual examination and laboratory risk factors between groups (A1c, systolic blood pressure, diastolic blood pressure, high-density lipoprotein, low-density lipoprotein, total cholesterol). However, epilepsy was associated with 52% (95% confidence interval [CI]: 0-130%) increase in ASCVD risk, which became nonsignificant after adjusting for health behaviors. No single studied variable (income, Patient Health Questionnaire-9 (PHQ-9), diet, smoking) had a significant indirect effect. Participants with epilepsy reported increased hypertension awareness which was trivially but significantly mediated by having a routine place of healthcare (indirect effect: 1% absolute increase (95% CI: 0-1%), and they reported increased rates of hypertension treatment and guideline-concordant statin therapy. Participants with versus without epilepsy reported similar rates of blood pressure control and diabetes awareness, treatment, and control.
Participants with epilepsy had increased ASCVD risk, despite similar or better awareness, treatment, and control of individual risk factors such as diabetes and hypertension. Our results suggest that epilepsy is associated with numerous health behaviors leading to cardiovascular disease, though the causal pathway is complex as these variables (income, depression, diet, exercise, smoking) generally served as confounders rather than mediators.
评估心血管风险、风险意识和指南一致的治疗在患有和不患有癫痫的个体中是否存在差异。
这是一项使用国家健康和营养检查调查的回顾性横断面研究。我们纳入了 2013 年至 2018 年期间年龄≥18 岁的参与者。如果报告≥1 种药物治疗癫痫发作，则将参与者归类为患有癫痫。我们使用修订后的 pooled cohort 方程计算了 10 年动脉粥样硬化性心血管疾病（ASCVD）风险。我们比较了患有和不患有癫痫的参与者的未调整和调整后的风险。然后，我们评估了高血压和糖尿病的疾病知晓率和控制率，以及他汀类药物的指南一致性。我们评估了 ASCVD 风险和心血管疾病知晓率的两个中介变量。
在 17961 名参与者中，有 154 名（0.9%）患有癫痫。患有癫痫的参与者报告的饮食较差（p=0.03），每天进行中等至剧烈活动的分钟数较少（p<0.01），并且心血管疾病的发病率增加（如冠心病、心肌梗死、中风）。两组之间个体检查和实验室危险因素的控制没有差异（糖化血红蛋白、收缩压、舒张压、高密度脂蛋白、低密度脂蛋白、总胆固醇）。然而，癫痫与 ASCVD 风险增加 52%（95%置信区间：0-130%）相关，在调整健康行为后，这一相关性不再显著。没有单个研究变量（收入、患者健康问卷-9（PHQ-9）、饮食、吸烟）具有显著的间接影响。患有癫痫的参与者报告高血压知晓率增加，这一增加微不足道但具有统计学意义，与常规医疗保健场所有关（间接效应：绝对增加 1%（95%置信区间：0-1%），并且他们报告高血压治疗和指南一致的他汀类药物治疗的比例增加。与不患有癫痫的参与者相比，患有癫痫的参与者报告的血压控制率和糖尿病知晓率、治疗率和控制率相似。
尽管患有癫痫的参与者对糖尿病和高血压等个体危险因素的意识、治疗和控制相似或更好，但他们的 ASCVD 风险仍然增加。我们的结果表明，癫痫与许多导致心血管疾病的健康行为有关，尽管因果关系很复杂，因为这些变量（收入、抑郁、饮食、运动、吸烟）通常是混杂因素而不是中介因素。
