Heart Attack Doubles Risk of Late-Onset Epilepsy in Older Adults, Neurology Study Finds
Key Clinical Summary
- Neurology, Northern Manhattan Study (US; n=3174; 1993–2008): Adults ≥40 years without prior stroke, MI, or epilepsy were followed for ≈14 years (mean age 69.1).
- Findings: Post–myocardial infarction (MI) epilepsy incidence = 7.02 vs 2.49 cases/1000 person-years; adjusted HR 2.12. Late-onset epilepsy increased MI risk (HR 1.99) and nonstroke vascular death (HR 2.82).
- Clinical note: Older adults with MI may warrant monitoring for late-onset seizures and continued management of cerebrovascular and vascular health.
A heart attack in older adults is linked to twice the risk of developing late-onset epilepsy, according to new research published in Neurology.
“In middle-aged and older adults, vascular disease can block, weaken, or narrow blood vessels, and it often affects multiple parts of the body at once,” said corresponding author Evan L. Thacker, PhD, of Brigham Young University in Provo, Utah, in a news release. “Our study found a first heart attack may flag cerebrovascular disease, a condition that affects blood vessels in the brain, which may raise the risk of epilepsy.”
Study Design and Population
The population-based cohort included 3174 adults aged 40 years and older from the Northern Manhattan Study. Enrollment ran from 1993 to 2008, with an average follow-up of 14 years. Participants had no history of stroke, heart attack, or epilepsy at baseline.
At enrollment, the average age was 69.1 years. During follow-up:
- 296 experienced a heart attack
- 120 developed late-onset epilepsy
- 794 died from vascular causes other than stroke (including heart attack, heart failure, irregular heartbeat, pulmonary embolism, or aortic aneurysm)
Key Outcomes
Rates of late-onset epilepsy after heart attack were 7.02 cases per 1000 person-years, compared with 2.49 cases per 1000 person-years in those without heart attack. After adjustment for demographics, health behaviors, and comorbidities, the hazard ratio (HR) was 2.12 for late-onset epilepsy among patients with heart attack.
Rates of incident heart attack after late-onset epilepsy were 17.68 vs 6.46 cases per 1000 person-years, for an adjusted HR of 1.99.
For nonstroke vascular death, rates reached 99.24 vs 16.29 per 1000 person-years, with an adjusted HR of 2.82 among patients who developed late-onset epilepsy.
“These findings highlight the interconnectedness that heart and vascular health may have with brain health in later life,” Dr Thacker said. “When an older adult has a heart attack, clinicians may want to stay alert for possible seizures later.”
Clinical Implications
The findings underscore the brain–heart connection in aging adults. A first myocardial infarction may serve as an early warning for cerebrovascular vulnerability, suggesting a need for proactive seizure monitoring and vascular risk management in post-MI care.
For clinicians, awareness of this association can support integrated cardiovascular and neurologic follow-up—especially in older populations with comorbid vascular conditions.
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