Seizures and Heart Disease Show Hidden Two-Way Links in Older Adults
A large population study reveals late-onset epilepsy may signal underlying vascular disease and increased risk of heart attack.
Topline:
A new analysis from the Northern Manhattan Study suggests that late-onset epilepsy (LOE) and heart attacks are connected in both directions. Adults over 40 who experienced a heart attack had double the risk of developing epilepsy later in life, while those who developed epilepsy showed nearly twice the risk of subsequent heart attack and non-stroke vascular deaths.
Study Details:
The Northern Manhattan Study followed 3,174 adults aged 40 and older who were free from stroke, heart attack, or epilepsy at baseline between 1993 and 2008. Researchers tracked how often individuals developed heart attacks, late-onset epilepsy, or vascular deaths over time.
Mean participant age was 69 years, and the population included a diverse community 54% Hispanic, 23% Black, and 20% white.
Methodology:
This observational cohort study analyzed bidirectional relationships between new-onset epilepsy after midlife and the later risk of myocardial infarction (MI). Using adjusted hazard ratios, the investigators explored how heart attacks and late-onset epilepsy correlated while excluding participants with prior stroke to isolate vascular influences.
Key Findings:
After a heart attack, the risk of developing late-onset epilepsy more than doubled (7.02 vs. 2.49 cases per 1,000 person-years; adjusted HR 2.12).
After epilepsy onset, the risk of heart attack nearly doubled (17.68 vs. 6.46 cases per 1,000 person-years; adjusted HR 1.99).
Non-stroke vascular deaths were markedly higher in those with late-onset epilepsy (adjusted HR 2.82).
These results suggest a shared vascular mechanism rather than direct cause-and-effect meaning systemic vascular disease may contribute to both epilepsy and heart disease in the same individuals.
Implications for Practice:
For clinicians, late-onset epilepsy should not be viewed as an isolated neurological condition but as a possible warning sign of systemic vascular disease. Cardiologists and neurologists may need to coordinate more closely on risk management, particularly in older adults.
Angiotensin receptor blockers medications often used for blood pressure control may offer dual benefits, potentially reducing the risk of seizures alongside heart protection, though clinical trials are needed to confirm this.
For patients and families, this research underscores the importance of managing vascular risk factors such as hypertension, diabetes, and high cholesterol, even when the first signs appear in the brain rather than the heart.