Vascular Risk Factors and Incident Epilepsy in Older Adults: A Pooled Cohort Analysis
Hyunmi Choi1, Jose Gutierrez1, Cheng-Shiun Leu1, Tian Wang1, Jiying Han1, Sylwia Misiewicz1, Emily Johnson2, Will Longstreth Jr3, Mary L. Biggs3, Annette Fitzpatrick3, Steven Shea1, Craig Johnson3, Mitchell S. V. Elkind1, Tatjana Rundek4, Kevin Strobino5, Lisandro Colantonio6, Lei Huang6, Carolyn Zhu7, Danurys Sanchez1, Dolly Reyes-Dumeyer1, Richard Mayeux1, Natalie Bello8, Deborah A. Levine9, Oluwadamilola Obalana10, Stefany Diaz10, Brian Petersen10, Sofia Maia10, Evan Thacker10
1Columbia University Medical Center, 2Johns Hopkins University School of Medicine, 3University of Washington, 4University of Miami, 5Cornell University Medical Center, 6University of Alabama at Birmingham, 7Icahn School of Medicine at Mount Sinai, 8Cedar Sinai Medical Center, 9University of Michigan, 10Brigham Young University
Objective:
To identify vascular risk factors (VRFs) for incident late-onset epilepsy (LOE) in older adults.
Background:
LOE (onset after age 65) is a common neurological disorder that may be associated with increased burden of VRFs.
Design/Methods:
We pooled individual participant data from five US cardiovascular cohorts: ARIC, CHS, MESA, NOMAS, and WHICAP. In ARIC, CHS, MESA, and WHICAP, we used Medicare claims to ascertain new-onset epilepsy occurring after the first 2 years of continuous Medicare enrollment using an algorithm based on ICD-9 or ICD-10 codes, and anti-seizure medications. In NOMAS, which was not linked to Medicare, we identified epilepsy using self-report, medical record review, and ICD-9 or ICD-10 codes in claims of the New York Statewide Planning and Research Cooperative System. D
Demographics were assessed by self-report, and VRFs by self-report, blood measures, EKG, physical exams, and medications.
Using individual participant meta-analysis with a fixed effect for cohort, we estimated the pooled cohort hazard ratios (HR) and 95% CI from multivariable Cox models. Participants were censored at death or end of continuous Medicare enrollment.
Results:
Among 28,291 participants with 294,575 person-years of follow-up, 998 developed LOE (3.39 per 1000 person-years). Findings from Cox regression analysis suggested that LOE risk was higher for those age ≥85 (HR 2.23 95%CI [1.58, 3.15]) compared to 65-75 years, non-Hispanic [NH] Black (1.80 [1.56, 2.09]) and Hispanic (1.36 [1.09, 1.69]) compared to NH White participants, and those with current smoking (1.40 [1.23, 1.59]), hypertension (1.40 [1.23, 1.59]), diabetes (1.62 [1.38, 1.90]), eGFR<60 (1.35 [1.14, 1.59]), stroke (1.77 [1.29, 2.41]), heart disease (1.39 [1.16, 1.67]), and one (1.29 [1.11, 1.50]) or two APOE e4 alleles (2.12 [1.51, 2.99]) compared to none.
Conclusions:
We identified VRFs that were independently associated with incident LOE. Potential mechanisms underlying the relationships between VRFs and LOE should be examined in future studies.
Disclaimer: Abstracts were not reviewed by Neurology® and do not reflect the views of Neurology® editors or staff.