The aim of this study is to evaluate the prevalence of atherosclerotic risk factors and cardiovascular diseases in patients with epilepsy/seizure disorders (ESD).

Patients with ESD are known to have an increased risk of sudden unexpected death in epilepsy (SUDEP). Although cardiopulmonary disease was suggested as the cause of SUDEP, the prevalence of atherosclerotic and cardiovascular diseases in patients with ESD has never been evaluated before.

A total amount of 325,260 and 25,153,670 patients with and without ESD were included into this study respectively. Patients with ESD had significant prevalence of atherosclerotic risk factors such as hypertension (5.8% vs 4.0%, P<0.001), diabetes mellitus (11.7% vs 7.0%, P<0.001), COPD (6.8% vs 2.0%, P<0.001), or tobacco use (27.0% vs 14.5%, P<0.001) compared with patients without ESD. Patients with ESD had significant prevalence of arrhythmia such as atrial fibrillation (1.7% vs 0.8%; p<0.001; odds ratio [OR] 2.08; 95% confidence interval [CI] 2.03-2.14), ventricular tachycardia (0.5% vs 0.2%; p<0.001; OR 2.7; 95% CI 2.57-2.85), and atrioventricular block (0.5% vs 0.2%; p<0.001; OR 3.11; 95% CI 2.96-3.23). They also had high prevalence of heart failure (2.6% vs 0.8%; p<0.001; OR 3.26; 95% CI 3.19-3.33) and cardiogenic shock (0.1% vs 0.0%; p<0.001; OR 4.12; 95% CI 3.63-4.68).

Although this study already excluded pre-existing critical atherosclerotic diseases, patients with ESD had significant prevalence of cardiovascular diseases. These underlying pathologies may contribute to provoke SUDEP and the utility of primary prevention in cardiovascular disease needs to be evaluated in patients with ESD.