Johnson EL, et al. - Using data from the Atherosclerosis Risk in Communities (ARIC) study, researchers conducted a prospective cohort study to determine midlife vascular and lifestyle risk factors for late-onset epilepsy. Findings demonstrated that potentially modifiable risk factors in midlife and the apolipoprotein E ε4 (APOE ε4) genotype were positively correlated with risk of developing late-onset epilepsy. It was noted that vascular and lifestyle risk factors were significant even in the absence of stroke or dementia, although stroke and dementia were both correlated with late-onset epilepsy.

Methods

• For this investigation, 15,792 participants were followed up since 1987 to 1989 with in-person visits, telephone calls, and surveillance of hospitalizations (10,974 invited without completing enrollment).
• The ARIC is a multicenter study with participants chose from four US communities.
• Ten thousand, four hundred twenty black or white participants from ARIC with at least 2 years of Medicare fee-for-service coverage and without missing baseline data were included.
• Between April 2017 and May 2018, data were analyzed.
• Researchers assessed demographic, vascular, lifestyle, and other possible epilepsy risk factors measured at baseline (age 45-64 years) in multivariable survival models including demographics, vascular risk factors, and lifestyle risk factors.
• Main outcome was time to development of late-onset epilepsy (2 or more International Classification of Diseases, Ninth Revision codes for epilepsy or seizures starting at 60 years or older in any claim [hospitalization or outpatient Medicare through 2013]), with first code for seizures after at least 2 years without code for seizures.

Results

• According to the findings, out of 10,420 total participants (5,878 women [56.4%] and 2,794 black participants [26.8%]; median age 55 years at first visit), 596 participants developed late-onset epilepsy (3.33 per 1,000 person-years).
• Higher incidence was found in black vs white participants (4.71; 95% CI, 4.12-5.40 vs 2.88; 95% CI, 2.60-3.18 per 1000 person-years).
• In multivariable analysis, baseline hypertension (hazard ratio [HR], 1.30; 95% CI, 1.09-1.55), diabetes (HR, 1.45; 95% CI, 1.17-1.80), smoking (HR, 1.09; 95% CI, 1.01-1.17), APOE ε4 genotype (1 allele HR, 1.22; 95% CI, 1.02-1.45; 2 alleles HR, 1.95; 95% CI, 1.35-2.81), and incident stroke (HR, 3.38; 95% CI, 2.78-4.10) and dementia (HR, 2.56; 95% CI, 2.11-3.12) were related to an increased risk of late-onset epilepsy.
• On the other hand, higher levels of physical activity (HR, 0.90; 95% CI, 0.83-0.98) and moderate alcohol intake (HR, 0.72; 95% CI, 0.57-0.90) were associated with a lower risk.
• The outcomes were similar after censoring individuals with stroke or dementia.