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Epilepsy, antiepileptic drugs, and the risk of major cardiovascular events

Elinor Lee‐Lane, Fatemeh Torabi Orcid Logo, Arron Lacey, Beata Fonferko-Shadrach, Daniel Harris, Ashley Akbari Orcid Logo, Ronan Lyons Orcid Logo, Mark Rees, Inder Sawhney, Julian Halcox Orcid Logo, Robert Powell, Owen Pickrell Orcid Logo

Epilepsia, Volume: 62, Issue: 7, Pages: 1604 - 1616

Swansea University Authors: Fatemeh Torabi Orcid Logo, Arron Lacey, Beata Fonferko-Shadrach, Ashley Akbari Orcid Logo, Ronan Lyons Orcid Logo, Mark Rees, Inder Sawhney, Julian Halcox Orcid Logo, Robert Powell, Owen Pickrell Orcid Logo

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DOI (Published version): 10.1111/epi.16930

Abstract

ObjectiveThis study was undertaken to determine whether epilepsy and antiepileptic drugs (including enzyme-inducing and non-enzyme-inducing drugs) are associated with major cardiovascular events using population-level, routinely collected data.MethodsUsing anonymized, routinely collected, health car...

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Published in: Epilepsia
ISSN: 0013-9580 1528-1167
Published: Wiley 2021
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URI: https://cronfa.swan.ac.uk/Record/cronfa56988
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Controls were matched with replacement on age, gender, deprivation quintile, and year of entry into the study. Participants were followed to the end of the study for the occurrence of a major cardiovascular event, and survival models were constructed to compare the time to a major cardiovascular event (cardiac arrest, myocardial infarction, stroke, ischemic heart disease, clinically significant arrhythmia, thromboembolism, onset of heart failure, or a cardiovascular death) for individuals in the case group versus the control group.ResultsThere were 10 241 cases (mean age = 49.6 years, 52.2% male, mean follow-up = 6.1 years) matched to 35 145 controls. A total of 3180 (31.1%) cases received enzyme-inducing antiepileptic drugs, and 7061 (68.9%) received non-enzyme-inducing antiepileptic drugs. Cases had an increased risk of experiencing a major cardiovascular event compared to controls (adjusted hazard ratio = 1.58, 95% confidence interval [CI] = 1.51&#x2013;1.63, p &lt; .001). There was no notable difference in major cardiovascular events between those treated with enzyme-inducing antiepileptic drugs and those treated with non-enzyme-inducing antiepileptic drugs (adjusted hazard ratio = .95, 95% CI = .86&#x2013;1.05, p = .300).SignificanceIndividuals with epilepsy prescribed antiepileptic drugs are at an increased risk of major cardiovascular events compared with population controls. Being prescribed an enzyme-inducing antiepileptic drug is not associated with a greater risk of a major cardiovascular event compared to treatment with other antiepileptic drugs. Our data emphasize the importance of cardiovascular risk management in the clinical care of people with epilepsy.</abstract><type>Journal Article</type><journal>Epilepsia</journal><volume>62</volume><journalNumber>7</journalNumber><paginationStart>1604</paginationStart><paginationEnd>1616</paginationEnd><publisher>Wiley</publisher><placeOfPublication/><isbnPrint/><isbnElectronic/><issnPrint>0013-9580</issnPrint><issnElectronic>1528-1167</issnElectronic><keywords>cardiovascular risk; enzyme-inducing antiepileptic drugs</keywords><publishedDay>1</publishedDay><publishedMonth>7</publishedMonth><publishedYear>2021</publishedYear><publishedDate>2021-07-01</publishedDate><doi>10.1111/epi.16930</doi><url/><notes/><college>COLLEGE NANME</college><department>Health Data Science</department><CollegeCode>COLLEGE CODE</CollegeCode><DepartmentCode>HDAT</DepartmentCode><institution>Swansea University</institution><apcterm>SU College/Department paid the OA fee</apcterm><funders>This work was supported by Health Data Research UK, which receives its funding from HDR UK (HDR-9006) funded by the UK Medical Research Council, Engineering and Physical Sciences Research Council, Economic and Social Research Council, Department of Health and Social Care (England), Chief Scientist Office of the Scottish Government Health and Social Care Directorates, Health and Social Care Research and Development Division (Welsh Government), Public Health Agency (Northern Ireland), British Heart Foundation, and Wellcome Trust. This work was supported by staff funded as part of the Brain Repair and Intracranial Neurotherapeutics (BRAIN) Unit Infrastructure Award (grant UA05). The BRAIN Unit is funded by the Welsh Government through Health and Care Research Wales. This study makes use of anonymized data held in the SAIL Databank.</funders><lastEdited>2022-07-18T15:05:47.2020393</lastEdited><Created>2021-05-31T12:48:19.0275346</Created><path><level id="1">Faculty of Medicine, Health and Life Sciences</level><level id="2">Swansea University Medical School - Medicine</level></path><authors><author><firstname>Elinor</firstname><surname>Lee&#x2010;Lane</surname><order>1</order></author><author><firstname>Fatemeh</firstname><surname>Torabi</surname><orcid>0000-0002-5853-4625</orcid><order>2</order></author><author><firstname>Arron</firstname><surname>Lacey</surname><order>3</order></author><author><firstname>Beata</firstname><surname>Fonferko-Shadrach</surname><order>4</order></author><author><firstname>Daniel</firstname><surname>Harris</surname><order>5</order></author><author><firstname>Ashley</firstname><surname>Akbari</surname><orcid>0000-0003-0814-0801</orcid><order>6</order></author><author><firstname>Ronan</firstname><surname>Lyons</surname><orcid>0000-0001-5225-000X</orcid><order>7</order></author><author><firstname>Mark</firstname><surname>Rees</surname><orcid/><order>8</order></author><author><firstname>Inder</firstname><surname>Sawhney</surname><order>9</order></author><author><firstname>Julian</firstname><surname>Halcox</surname><orcid>0000-0001-6926-2947</orcid><order>10</order></author><author><firstname>Robert</firstname><surname>Powell</surname><order>11</order></author><author><firstname>Owen</firstname><surname>Pickrell</surname><orcid>0000-0003-4396-5657</orcid><order>12</order></author></authors><documents><document><filename>56988__20149__8c03c15aa65f42eea925acdc4c1da8c5.pdf</filename><originalFilename>56988.pdf</originalFilename><uploaded>2021-06-14T14:05:29.7561084</uploaded><type>Output</type><contentLength>852438</contentLength><contentType>application/pdf</contentType><version>Version of Record</version><cronfaStatus>true</cronfaStatus><documentNotes>&#xA9; 2021 The Authors. 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spelling 2022-07-18T15:05:47.2020393 v2 56988 2021-05-31 Epilepsy, antiepileptic drugs, and the risk of major cardiovascular events f569591e1bfb0e405b8091f99fec45d3 0000-0002-5853-4625 Fatemeh Torabi Fatemeh Torabi true false b69d245574e754d2637cc9e76379fe11 Arron Lacey Arron Lacey true false 7d3f1e80939f2b8fab6a16b5ec6ac845 Beata Fonferko-Shadrach Beata Fonferko-Shadrach true false aa1b025ec0243f708bb5eb0a93d6fb52 0000-0003-0814-0801 Ashley Akbari Ashley Akbari true false 83efcf2a9dfcf8b55586999d3d152ac6 0000-0001-5225-000X Ronan Lyons Ronan Lyons true false 10f39a4e9c2ee00d453cd84c10667ac8 Mark Rees Mark Rees true false f66d710c41a46bbb0f141e06c029a943 Inder Sawhney Inder Sawhney true false 3676f695eeda169d0f8c618adf27c04b 0000-0001-6926-2947 Julian Halcox Julian Halcox true false 7c8ac48bb6ae4281930e4138f94a51b6 Robert Powell Robert Powell true false 1c3044b5ff7a6552ff5e8c9e3901c807 0000-0003-4396-5657 Owen Pickrell Owen Pickrell true false 2021-05-31 HDAT ObjectiveThis study was undertaken to determine whether epilepsy and antiepileptic drugs (including enzyme-inducing and non-enzyme-inducing drugs) are associated with major cardiovascular events using population-level, routinely collected data.MethodsUsing anonymized, routinely collected, health care data in Wales, UK, we performed a retrospective matched cohort study (2003–2017) of adults with epilepsy prescribed an antiepileptic drug. Controls were matched with replacement on age, gender, deprivation quintile, and year of entry into the study. Participants were followed to the end of the study for the occurrence of a major cardiovascular event, and survival models were constructed to compare the time to a major cardiovascular event (cardiac arrest, myocardial infarction, stroke, ischemic heart disease, clinically significant arrhythmia, thromboembolism, onset of heart failure, or a cardiovascular death) for individuals in the case group versus the control group.ResultsThere were 10 241 cases (mean age = 49.6 years, 52.2% male, mean follow-up = 6.1 years) matched to 35 145 controls. A total of 3180 (31.1%) cases received enzyme-inducing antiepileptic drugs, and 7061 (68.9%) received non-enzyme-inducing antiepileptic drugs. Cases had an increased risk of experiencing a major cardiovascular event compared to controls (adjusted hazard ratio = 1.58, 95% confidence interval [CI] = 1.51–1.63, p < .001). There was no notable difference in major cardiovascular events between those treated with enzyme-inducing antiepileptic drugs and those treated with non-enzyme-inducing antiepileptic drugs (adjusted hazard ratio = .95, 95% CI = .86–1.05, p = .300).SignificanceIndividuals with epilepsy prescribed antiepileptic drugs are at an increased risk of major cardiovascular events compared with population controls. Being prescribed an enzyme-inducing antiepileptic drug is not associated with a greater risk of a major cardiovascular event compared to treatment with other antiepileptic drugs. Our data emphasize the importance of cardiovascular risk management in the clinical care of people with epilepsy. Journal Article Epilepsia 62 7 1604 1616 Wiley 0013-9580 1528-1167 cardiovascular risk; enzyme-inducing antiepileptic drugs 1 7 2021 2021-07-01 10.1111/epi.16930 COLLEGE NANME Health Data Science COLLEGE CODE HDAT Swansea University SU College/Department paid the OA fee This work was supported by Health Data Research UK, which receives its funding from HDR UK (HDR-9006) funded by the UK Medical Research Council, Engineering and Physical Sciences Research Council, Economic and Social Research Council, Department of Health and Social Care (England), Chief Scientist Office of the Scottish Government Health and Social Care Directorates, Health and Social Care Research and Development Division (Welsh Government), Public Health Agency (Northern Ireland), British Heart Foundation, and Wellcome Trust. This work was supported by staff funded as part of the Brain Repair and Intracranial Neurotherapeutics (BRAIN) Unit Infrastructure Award (grant UA05). The BRAIN Unit is funded by the Welsh Government through Health and Care Research Wales. This study makes use of anonymized data held in the SAIL Databank. 2022-07-18T15:05:47.2020393 2021-05-31T12:48:19.0275346 Faculty of Medicine, Health and Life Sciences Swansea University Medical School - Medicine Elinor Lee‐Lane 1 Fatemeh Torabi 0000-0002-5853-4625 2 Arron Lacey 3 Beata Fonferko-Shadrach 4 Daniel Harris 5 Ashley Akbari 0000-0003-0814-0801 6 Ronan Lyons 0000-0001-5225-000X 7 Mark Rees 8 Inder Sawhney 9 Julian Halcox 0000-0001-6926-2947 10 Robert Powell 11 Owen Pickrell 0000-0003-4396-5657 12 56988__20149__8c03c15aa65f42eea925acdc4c1da8c5.pdf 56988.pdf 2021-06-14T14:05:29.7561084 Output 852438 application/pdf Version of Record true © 2021 The Authors. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License true eng http://creativecommons.org/licenses/by-nc/4.0/
title Epilepsy, antiepileptic drugs, and the risk of major cardiovascular events
spellingShingle Epilepsy, antiepileptic drugs, and the risk of major cardiovascular events
Fatemeh Torabi
Arron Lacey
Beata Fonferko-Shadrach
Ashley Akbari
Ronan Lyons
Mark Rees
Inder Sawhney
Julian Halcox
Robert Powell
Owen Pickrell
title_short Epilepsy, antiepileptic drugs, and the risk of major cardiovascular events
title_full Epilepsy, antiepileptic drugs, and the risk of major cardiovascular events
title_fullStr Epilepsy, antiepileptic drugs, and the risk of major cardiovascular events
title_full_unstemmed Epilepsy, antiepileptic drugs, and the risk of major cardiovascular events
title_sort Epilepsy, antiepileptic drugs, and the risk of major cardiovascular events
author_id_str_mv f569591e1bfb0e405b8091f99fec45d3
b69d245574e754d2637cc9e76379fe11
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aa1b025ec0243f708bb5eb0a93d6fb52
83efcf2a9dfcf8b55586999d3d152ac6
10f39a4e9c2ee00d453cd84c10667ac8
f66d710c41a46bbb0f141e06c029a943
3676f695eeda169d0f8c618adf27c04b
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author_id_fullname_str_mv f569591e1bfb0e405b8091f99fec45d3_***_Fatemeh Torabi
b69d245574e754d2637cc9e76379fe11_***_Arron Lacey
7d3f1e80939f2b8fab6a16b5ec6ac845_***_Beata Fonferko-Shadrach
aa1b025ec0243f708bb5eb0a93d6fb52_***_Ashley Akbari
83efcf2a9dfcf8b55586999d3d152ac6_***_Ronan Lyons
10f39a4e9c2ee00d453cd84c10667ac8_***_Mark Rees
f66d710c41a46bbb0f141e06c029a943_***_Inder Sawhney
3676f695eeda169d0f8c618adf27c04b_***_Julian Halcox
7c8ac48bb6ae4281930e4138f94a51b6_***_Robert Powell
1c3044b5ff7a6552ff5e8c9e3901c807_***_Owen Pickrell
author Fatemeh Torabi
Arron Lacey
Beata Fonferko-Shadrach
Ashley Akbari
Ronan Lyons
Mark Rees
Inder Sawhney
Julian Halcox
Robert Powell
Owen Pickrell
author2 Elinor Lee‐Lane
Fatemeh Torabi
Arron Lacey
Beata Fonferko-Shadrach
Daniel Harris
Ashley Akbari
Ronan Lyons
Mark Rees
Inder Sawhney
Julian Halcox
Robert Powell
Owen Pickrell
format Journal article
container_title Epilepsia
container_volume 62
container_issue 7
container_start_page 1604
publishDate 2021
institution Swansea University
issn 0013-9580
1528-1167
doi_str_mv 10.1111/epi.16930
publisher Wiley
college_str Faculty of Medicine, Health and Life Sciences
hierarchytype
hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str Swansea University Medical School - Medicine{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}Swansea University Medical School - Medicine
document_store_str 1
active_str 0
description ObjectiveThis study was undertaken to determine whether epilepsy and antiepileptic drugs (including enzyme-inducing and non-enzyme-inducing drugs) are associated with major cardiovascular events using population-level, routinely collected data.MethodsUsing anonymized, routinely collected, health care data in Wales, UK, we performed a retrospective matched cohort study (2003–2017) of adults with epilepsy prescribed an antiepileptic drug. Controls were matched with replacement on age, gender, deprivation quintile, and year of entry into the study. Participants were followed to the end of the study for the occurrence of a major cardiovascular event, and survival models were constructed to compare the time to a major cardiovascular event (cardiac arrest, myocardial infarction, stroke, ischemic heart disease, clinically significant arrhythmia, thromboembolism, onset of heart failure, or a cardiovascular death) for individuals in the case group versus the control group.ResultsThere were 10 241 cases (mean age = 49.6 years, 52.2% male, mean follow-up = 6.1 years) matched to 35 145 controls. A total of 3180 (31.1%) cases received enzyme-inducing antiepileptic drugs, and 7061 (68.9%) received non-enzyme-inducing antiepileptic drugs. Cases had an increased risk of experiencing a major cardiovascular event compared to controls (adjusted hazard ratio = 1.58, 95% confidence interval [CI] = 1.51–1.63, p < .001). There was no notable difference in major cardiovascular events between those treated with enzyme-inducing antiepileptic drugs and those treated with non-enzyme-inducing antiepileptic drugs (adjusted hazard ratio = .95, 95% CI = .86–1.05, p = .300).SignificanceIndividuals with epilepsy prescribed antiepileptic drugs are at an increased risk of major cardiovascular events compared with population controls. Being prescribed an enzyme-inducing antiepileptic drug is not associated with a greater risk of a major cardiovascular event compared to treatment with other antiepileptic drugs. Our data emphasize the importance of cardiovascular risk management in the clinical care of people with epilepsy.
published_date 2021-07-01T04:12:22Z
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score 11.037581

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