Narcolepsy Increases Risk For Cardiovascular Disease

Patients with narcolepsy have a significantly greater risk for cardiovascular disease (CVD) and major adverse cardiovascular events (MACE), even after accounting for stimulant use. These findings were published in Sleep.

Researchers conducted a large-scale retrospective cohort study to assess whether narcolepsy independently increases cardiovascular risk. Patients with newly diagnosed narcolepsy (n=34,562) were compared with matched control individuals without narcolepsy or hypersomnia (n=100,405). The researchers used propensity score matching based on demographics, comorbid conditions, and baseline use of medication. Medications specific to narcolepsy, such as stimulants, oxybate, and wake promoting agents, were excluded from the propensity score model but adjusted for in multivariable regression analyses.

Among the participants, the mean (SD) age was 39.9 (16.8) years, and 61.5% were women. Common baseline comorbidities included sleep apnea (36.8%) and mood disorders (28.7%). Use of selective serotonin reuptake inhibitors (24.2%), benzodiazepines (23.8%), and serotonin and norepinephrine reuptake inhibitors (20.9%) were also prevalent in the narcolepsy cohort.

Taking stimulant use into account, patients with narcolepsy exhibited a significantly elevated risk for incident CVD (adjusted hazard ratio [aHR], 1.89; 95% CI, 1.71-2.09) and major adverse cardiovascular events (aHR, 1.95; 95% CI, 1.70-2.23) compared with matched control individuals. Increased risk remained consistent across outcomes, including heart failure (aHR, 1.90; 95% CI, 1.61-2.24), stroke (aHR, 2.06; 95% CI, 1.73-2.45), and myocardial infarction (aHR, 1.93; 95% CI, 1.48-2.51).

Subgroup analyses stratified by age, sex, and presence of comorbidities yielded similar results. No significant difference in risk was observed between narcolepsy type 1 and type 2. Sensitivity analyses excluding patients who received oxybate or wake-promoting agents prior to diagnosis further confirmed findings.

Study limitations include the inability to confirm narcolepsy diagnosis using clinical or laboratory testing, potential residual confounding from unmeasured variables, and reliance on claims-based diagnoses.

“[P]atients with narcolepsy should undergo routine screening for CVD and receive monitoring as measures to mitigate the potential risk of CVD,” the study authors concluded.

Disclosures: This research was supported by the Sleep Research Society Foundation. Multiple study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.