London North West University Healthcare NHS Trust, London, United Kingdom.
Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA; Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic, Rochester, Minnesota, USA; WellSpan Center for Inherited Cardiovascular Diseases, WellSpan Health, York, Pennsylvania, USA.
Can J Cardiol. 2024 Apr;40(4):688-695. doi: 10.1016/j.cjca.2023.11.021. Epub 2023 Nov 25.
Sudden death is the leading cause of mortality in medically refractory epilepsy. Middle-aged persons with epilepsy (PWE) are under investigated regarding their mortality risk and burden of cardiovascular disease (CVD).
Using UK Biobank, we identified 7786 (1.6%) participants with diagnoses of epilepsy and 6,171,803 person-years of follow-up (mean 12.30 years, standard deviation 1.74); 566 patients with previous histories of stroke were excluded. The 7220 PWE comprised the study cohort with the remaining 494,676 without epilepsy as the comparator group. Prevalence of CVD was determined using validated diagnostic codes. Cox proportional hazards regression was used to assess all-cause mortality and sudden death risk.
Hypertension, coronary artery disease, heart failure, valvular heart disease, and congenital heart disease were more prevalent in PWE. Arrhythmias including atrial fibrillation/flutter (12.2% vs 6.9%; P < 0.01), bradyarrhythmias (7.7% vs 3.5%; P < 0.01), conduction defects (6.1% vs 2.6%; P < 0.01), and ventricular arrhythmias (2.3% vs 1.0%; P < 0.01), as well as cardiac implantable electric devices (4.6% vs 2.0%; P < 0.01) were more prevalent in PWE. PWE had higher adjusted all-cause mortality (hazard ratio [HR], 3.9; 95% confidence interval [CI], 3.01-3.39), and sudden death-specific mortality (HR, 6.65; 95% CI, 4.53-9.77); and were almost 2 years younger at death (68.1 vs 69.8; P < 0.001).
Middle-aged PWE have increased all-cause and sudden death-specific mortality and higher burden of CVD including arrhythmias and heart failure. Further work is required to elucidate mechanisms underlying all-cause mortality and sudden death risk in PWE of middle age, to identify prognostic biomarkers and develop preventative therapies in PWE.
猝死是抗药性癫痫患者死亡的主要原因。关于中年癫痫患者（PWE）的死亡率和心血管疾病（CVD）负担，研究仍不够充分。
我们利用英国生物银行（UK Biobank）的数据，共识别出 7786 名（占 1.6%）患有癫痫诊断的参与者和 6171803 人年的随访（平均随访 12.30 年，标准差为 1.74 年）；排除了 566 名有中风既往史的患者。7220 名 PWE 组成了研究队列，其余 494676 名无癫痫的患者作为对照组。采用验证性诊断代码确定 CVD 的患病率。采用 Cox 比例风险回归评估全因死亡率和猝死风险。
PWE 中高血压、冠状动脉疾病、心力衰竭、瓣膜性心脏病和先天性心脏病更为常见。心律失常包括心房颤动/扑动（12.2%比 6.9%；P<0.01）、心动过缓（7.7%比 3.5%；P<0.01）、传导障碍（6.1%比 2.6%；P<0.01）和室性心律失常（2.3%比 1.0%；P<0.01）以及心脏植入式电子设备（4.6%比 2.0%；P<0.01）更为常见。PWE 的全因死亡率（风险比[HR]，3.9；95%置信区间[CI]，3.01-3.39）和猝死特异性死亡率（HR，6.65；95%CI，4.53-9.77）调整后更高，死亡时年龄也小近 2 岁（68.1 比 69.8；P<0.001）。
中年 PWE 的全因死亡率和猝死特异性死亡率更高，且 CVD 负担更重，包括心律失常和心力衰竭。需要进一步研究阐明中年 PWE 全因死亡率和猝死风险的机制，以确定预后生物标志物并开发针对 PWE 的预防治疗方法。
