Association Between Status Epilepticus and Cardiovascular Risk
Takafumi Kubota1, Takahiro Tsushima2, Guadalupe Fernandez-Baca Vaca1
1Department of Neurology, 2Department of Medicine, University Hospitals of Cleveland Medical Center
Objective:

The aim of this study is to evaluate the prevalence of cardiovascular diseases in patients with status epilepticus (SE).

Background:

Patients with status epilepticus are at increased risk of sudden unexpected death in epilepsy (SUDEP). The association between SE and cardiovascular risk factors and diseases is not well understood.

Design/Methods:

We used a cloud-based aggregated electronic medical records from over 60 million unique patients in the US (Explorys, IBM Watson) to identify adults (18-65 years) with epilepsy/seizure disorders (ESD) with and without SE.   Patients with history of cerebrovascular disease, ischemic heart disease, and cardiac arrest were excluded from this study.

Results:

Out of 337,570 patients with ESD, 12310 had SE. Patients with SE had significantly higher prevalence of cardiovascular risk factors such as hypertension (7.7% vs 4.0%, P<0.001), diabetes mellitus (13.2% vs 7.0%, P<0.001, tobacco use (28.4% vs 14.5%, P<0.001) compared with patients without SE. Patients with SE were also more likely to have atrial fibrillation (odds ratio [OR] 3.24; 95% confidence interval [CI] 2.90-3.62, P<0.001), ventricular tachycardia (OR 5.82; 95% CI 4.86-6.97), and atrioventricular block (OR 5.45; 95% CI 4.53-6.60, P<0.001), heart failure (OR 4.66; 95% CI 4.25-5.12, P<0.001) and cardiogenic shock (OR 8.73; 95% CI 5.62-13.5, P<0.001).

Conclusions:

In this large study, patients with SE had significantly increased prevalence of cardiovascular risk factors, and were more likely to have cardiovascular disease. Underlying cardiovascular disease may contribute to SUDEP in patients with SE. The utility of cardiovascular screening in patients with SE needs to be investigated.