Prevalence of cardiovascular risk factors in people with epilepsy

Vivanco-Hidalgo, Rosa María; Gómez, Alejandra; Moreira, Antía; Díez, Laura González; Elosúa, Roberto; Roquer, Jaume

doi:10.1002/brb3.618

Cited by 19 publications

(18 citation statements)

References 22 publications

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“…In the same way, age was associated with the presence of dyslipidemia (28) and HTN (29). The association found between epilepsy and dyslipidemia is consistent with the known effect on lipids from treatment with certain anti-epileptic drugs (30, 31).…”

Section: Discussionsupporting

confidence: 85%

Structural Equation Model (SEM) of Stroke Mortality in Spanish Inpatient Hospital Settings: The Role of Individual and Contextual Factors

et al. 2019

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Introduction: Traditionally, predictive models of in-hospital mortality in ischemic stroke have focused on individual patient variables, to the neglect of in-hospital contextual variables. In addition, frequently used scores are betters predictors of risk of sequelae than mortality, and, to date, the use of structural equations in elaborating such measures has only been anecdotal. Aims: The aim of this paper was to analyze the joint predictive weight of the following: (1) individual factors (age, gender, obesity, and epilepsy) on the mediating factors (arrhythmias, dyslipidemia, hypertension), and ultimately death (exitus); (2) contextual in-hospital factors (year and existence of a stroke unit) on the mediating factors (number of diagnoses, procedures and length of stay, and re-admission), as determinants of death; and (3) certain factors in predicting others. Material and Methods: Retrospective cohort study through observational analysis of all hospital stays of Diagnosis Related Group (DRG) 14, non-lysed ischemic stroke, during the time period 2008–2012. The sample consisted of a total of 186,245 hospital stays, taken from the Minimum Basic Data Set (MBDS) upon discharge from Spanish hospitals. MANOVAs were carried out to establish the linear effect of certain variables on others. These formed the basis for building the Structural Equation Model (SEM), with the corresponding parameters and restrictive indicators. Results: A consistent model of causal predictive relationships between the postulated variables was obtained. One of the most interesting effects was the predictive value of contextual variables on individual variables, especially the indirect effect of the existence of stroke units on reducing number of procedures, readmission and in-hospital mortality. Conclusion: Contextual variables, and specifically the availability of stroke units, made a positive impact on individual variables that affect prognosis and mortality in ischemic stroke. Moreover, it is feasible to determine this impact through the use of structural equation methodology. We analyze the methodological and clinical implications of this type of study for hospital policies.

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Section: Discussionsupporting

confidence: 85%

Structural Equation Model (SEM) of Stroke Mortality in Spanish Inpatient Hospital Settings: The Role of Individual and Contextual Factors

et al. 2019

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“…These acute effects are likely to be induced by inhibition of voltage-gated sodium and calcium channels with subsequent decrease of cardiac contractility and SV [for review see e.g., (95)]. Probably the most common effects of anti-seizure agents on BP are of indirect nature and related to weight gain [e.g., upon intake of valproic acid, gabapentin, and pregabalin (6)] and detrimental effects on circulating cardiovascular risk factors such as dyslipidemia and hyperhomocysteinemia mostly caused by enzyme-inducing anti-seizure drugs (e.g., carbamazepine, phenobarbital, phenytoin) which in turn may lead to atherosclerosis with decreased blood vessel flexibility and reactivity (96–98). A minor subgroup of cases with sudden death may be explainable due to genetic overlaps with genetically caused cardiac arrhythmias and epilepsy, e.g., by mutations in potassium channel genes KCNQ1 and KCNH2 or sodium channel genes SCN5A (99).…”

Section: Interictal Alterations Of Blood Pressure and Baroreflex In Ementioning

confidence: 99%

Blood Pressure in Seizures and Epilepsy

et al. 2019

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In this narrative review, we summarize the current knowledge of neurally mediated blood pressure (BP) control and discuss how recently described epilepsy- and seizure-related BP alterations may contribute to premature mortality and sudden unexpected death in epilepsy (SUDEP). Although people with epilepsy display disturbed interictal autonomic function with a shift toward predominant sympathetic activity, prevalence of arterial hypertension is similar in people with and without epilepsy. BP is transiently increased in association with most types of epileptic seizures but may also decrease in some, illustrating that seizure activity can cause both a decrease and increase of BP, probably because of stimulation or inhibition of distinct central autonomic function by epileptic activity that propagates into different neuronal networks of the central autonomic nervous system. The principal regulatory neural loop for short-term BP control is termed baroreflex, mainly involving peripheral sensors and brain stem nuclei. The baroreflex sensitivity (BRS, expressed as change of interbeat interval per change in BP) is intact after focal seizures, whereas BRS is markedly impaired in the early postictal period following generalized convulsive seizures (GCS), possibly due to metabolically mediated muscular hyperemia in skeletal muscles, a massive release of catecholamines and compromised brain stem function. Whilst most SUDEP cases are probably caused by a cardiorespiratory failure during the early postictal period following GCS, a profoundly disturbed BRS may allow a life-threatening drop of systemic BP in the aftermath of GCS, as recently reported in a patient as a plausible cause of SUDEP in a few patients.

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“…Studies show that epileptic patients have a higher risk of comorbidities including dyslipidemia [10,30], which is a risk factor of cardiovascular disease. One of the risk factors of dyslipidemia can be antiepileptic treatment, but it cannot be clearly determined which kind of medication (drugs and drug combinations) has the greatest impact [31].…”

Section: Discussionmentioning

confidence: 99%

“…One of them, the California Health Interview Survey, concluded that the eating behavior and physical tness in epilepsy are similar to these of healthy people [28]. In contrast, some evidence shows that epilepsy may increase overweight and obesity, as well as the risk of cardiovascular diseases [10]. The percentage of overweight and obesity measured in our study was 53.4% for epilepsy patients and 52.8% for healthy controls, which was similar to another study where this percentage was 55.2% [34].…”

Section: Discussionmentioning

confidence: 99%

“…An important problem in epilepsy is co-occurrence of diet-related disorders. The epileptic population is characterized by a higher risk of cardiovascular disease (CVD) and dyslipidemia, which may be a consequence of behavioral risk factors, medication, or seizure-related cardiac arrythmias [9,10,11]. In addition to this, epileptic patients tend to have excessive body weight and abdominal obesity, which is risk factor of metabolic diseases [12].…”

Section: Introductionmentioning

confidence: 99%

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Dietary and Lifestyle Behavior in Adults With Epilepsy Needs Improvement: A Case-control Study From North-eastern Poland

Kulesza

Cyuńczyk

Kochanowicz

et al. 2020

Preprint

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Background: Several factors predispose people with epilepsy to cardiovascular diseases. Among them nutrition and lifestyle have not been sufficiently studied. Methods. The study involved 60 epileptic male and female volunteers and 70 healthy controls, corresponding to age and gender. Medical information was collected during the study and a detailed questionnaire survey concerning eating and lifestyle habits was conducted. Physical activity was evaluated using International Physical Activity Questionnaire (IPAQ). Nutritional status was assessed by bioelectric impedance. Venous blood samples were taken for lipid and 25-hydroxyvitamin D3 (25(OH)D3) analyses. Results. A tendency to an increase in LDL cholesterol was found in epileptics. Significantly higher body fat and insignificantly higher visceral fat was found in epileptic men compared to healthy men. In epileptic women a tendency to lower lean body mass was found. Patients with epilepsy were more sedentary, had lower consumption of cottage cheese, fruit, pulses, nuts and seeds, vitamin C and potassium, and higher intake of sugar-sweetened soda, energy from fat and sodium compared to healthy people. As a positive point, epileptics consumed less coffee and alcoholic beverages. More than 80% of diets of epilepsy people were low in folic acid, vitamin D and calcium, but similar tendency was observed in the healthy people. The diets of patients with epilepsy were in a higher percentage poor in niacin, vitamin C and potassium compared to the control group, 25% to 7%, 50% to 31% and 73 to 56% respectively. A significantly lower serum concentration of 25(OH)D3 was observed in epileptic individuals, which in this group was found to be positively modulated by physical activity.Conclusions. The study indicates that several behavior-related habits, which may predispose epileptic people to cardiovascular disease, need to be improved. For this reason, patients with epilepsy should be provided with more comprehensive medical care, including advice on nutrition and physical activity.

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Prevalence of cardiovascular risk factors in people with epilepsy

Cited by 19 publications

References 22 publications

Structural Equation Model (SEM) of Stroke Mortality in Spanish Inpatient Hospital Settings: The Role of Individual and Contextual Factors

Structural Equation Model (SEM) of Stroke Mortality in Spanish Inpatient Hospital Settings: The Role of Individual and Contextual Factors

Blood Pressure in Seizures and Epilepsy

Dietary and Lifestyle Behavior in Adults With Epilepsy Needs Improvement: A Case-control Study From North-eastern Poland

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