Exploring the Cardiovascular Burden of Narcolepsy

The onset of cardiovascular events and risk factors is high among those living with narcolepsy, even among patients who do not have a history of these cardiovascular conditions. As a result, patients’ physicians need to consider cardiovascular risks when considering treatment plans for those living with the sleep disorder.¹

These are the conclusions of the CardioVascular Burden Of Narcolepsy Disease (CV-BOND) study that Rami H. Ben-Joseph, Ph.D., head of big data real world evidence at Jazz, recently presented at the American Academy of Neurology (AAN) Annual Meeting 2022.

Existing research has shown that high rates of comorbidities are seen in people living with narcolepsy, a chronic neurological condition that often requires long-term treatment, resulting in a substantial impact on these patients’ lives. Additionally, narcolepsy has been associated with an increased risk of hypertension and cardiovascular disease.^2,3

The CV-BOND study set out to measure this excess risk of new-onset cardiovascular events in adults living with narcolepsy. To do so, researchers conducted a retrospective analysis of U.S. Healthcare claims from the IBM^® MarketScan^® database. Cardiovascular outcomes assessed included any stroke, atrial fibrillation, heart failure, myocardial infarction, among others.

Each analysis was applied to a patient population that did not have an event of interest in the six-month period prior to study entry. Patients were followed from one day after cohort entry until they experienced the outcome of interest for that analysis, or end of study period. Differences in outcome incidences between the narcolepsy (n=12,816) and non-narcolepsy (38,441) cohorts were evaluated using a Cox proportional hazard model adjusted for age, sex, region, insurance type and relevant morbidities and comorbidities.

At baseline, patients living with narcolepsy had more comorbidities compared with those not living with the sleep disorder. This included higher rates of sleep apnea, hypersomnia, mood and anxiety disorders, diabetes and prior cardiovascular disease.¹

As expected, unadjusted incidence rates for new-onset cardiovascular events were higher in patients with narcolepsy than those without, including any stroke (4.3 versus 2.2 unadjusted incidence per 1,000 person-years), cardiovascular disease (13.3 versus 8.0) and heart failure (5.7 versus 3.4). The only exception to this was myocardial infarction, as few of these happened across the study.¹

Of note, adjusted hazard ratios of the study demonstrated increased risk of new-onset cardiovascular risks in those living with narcolepsy. Differences were observed in events such as stroke (Adjusted HR [95% CI] 1.71), heart failure (1.35), major adverse cardiac events (1.45) and cardiovascular disease (1.30), with the only outlier being atrial fibrillation (0.98).¹

In conclusion, the CV-BOND study built upon previous research to prove the onset of cardiovascular events and risk factors is high among people with narcolepsy, even those who do not have a history of each condition. The clinical profile of these patients is dynamic and evolving, which increases their risk of negative cardiovascular outcomes in the future. Because the research established that even patients who are not currently presenting cardiovascular disease are at a higher risk for these events in the future, physicians must keep this correlation in mind when determining the best treatment plan.

To learn more about the cardiovascular comorbidities associated with narcolepsy, healthcare providers can visit narcolepsylink.com.