了解老年癫痫患者的心血管疾病。

Understanding cardiovascular disease in older adults with epilepsy.

机构信息

Research Centre of the University of Montreal Hospital Centre, Montreal, Quebec, Canada.

Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.

出版信息

Epilepsia. 2021 Sep;62(9):2060-2071. doi: 10.1111/epi.16991. Epub 2021 Jul 9.

DOI:10.1111/epi.16991

PMID:34245013

Abstract

OBJECTIVE

This study was undertaken to investigate the distribution of social, lifestyle/behavior, and chronic disease risk factors for cardiovascular disease (CVD) in people with epilepsy as compared to the general population. We also measured the cross-sectional association between epilepsy and CVD in older adults, with and without adjustments for a history of stroke.

METHODS

We analyzed data for 44 817 participants in the Canadian Longitudinal Study on Aging, including 751 individuals with a lifetime history of epilepsy. We modeled associations using ordinal and binomial logistic regression, as well as log-binomial regression, with multiple imputation for missing data. We measured the attributable fraction of CVD burden due to stroke.

RESULTS

The majority of the CVD risk factors were significantly more prevalent in people with epilepsy as compared to the general population without epilepsy, independent of age and sex. After adjusting for a history of stroke, people with epilepsy had a significantly higher prevalence of heart disease (prevalence ratio [PR] = 1.27, 95% confidence interval [CI] = 1.02-1.57) and peripheral vascular disease (PR = 1.88, 95% CI = 1.50-2.36). Stroke accounted for 36% (95% CI = 19.85-48.76) of the increased prevalence of any CVD among people with epilepsy, similar to the 32% (95% CI = 27.82-36.25) among people without epilepsy. After adjustment for all other CVD risk factors, peripheral vascular disease remained significantly more prevalent (PR = 1.65, 95% CI = 1.28-2.12) in people with epilepsy as compared to those without.

SIGNIFICANCE

CVD risk factors are more prevalent in people with epilepsy, independent of age and sex, and the association between epilepsy and CVD is independent of the association between epilepsy and stroke. The association between peripheral vascular disease and epilepsy may differ from the associations with other types of CVD. These findings are important steps in more comprehensively understanding the origins of CVD in people with epilepsy.

摘要

目的

本研究旨在调查与普通人群相比，癫痫患者的社会、生活方式/行为和慢性疾病心血管疾病（CVD）风险因素的分布情况。我们还测量了老年人中癫痫与 CVD 的横断面关联，以及在有无中风史的情况下进行调整。

方法

我们分析了加拿大老龄化纵向研究中 44817 名参与者的数据，包括 751 名有终身癫痫史的个体。我们使用有序和二项逻辑回归以及对数二项回归来模拟关联，对缺失数据进行多重插补。我们测量了由于中风导致的 CVD 负担的归因分数。

结果

与无癫痫的普通人群相比，大多数 CVD 风险因素在癫痫患者中更为常见，且独立于年龄和性别。在调整了中风史后，癫痫患者心脏病（患病率比 [PR] = 1.27，95%置信区间 [CI] = 1.02-1.57）和外周血管疾病（PR = 1.88，95%CI = 1.50-2.36）的患病率显著更高。在癫痫患者中，任何 CVD 的患病率增加了 36%（95%CI = 19.85-48.76），这归因于中风，与无癫痫患者中的 32%（95%CI = 27.82-36.25）相似。在调整了所有其他 CVD 风险因素后，与无癫痫患者相比，外周血管疾病在癫痫患者中仍然更为常见（PR = 1.65，95%CI = 1.28-2.12）。