A new long-term study has found that older adults who suffer a heart attack face a significantly higher risk of developing late-onset epilepsy. The research, which followed thousands of individuals for up to three decades, suggests a powerful link between cardiovascular health and neurological conditions in later life, highlighting that a heart attack could serve as an early warning sign for underlying blood vessel problems in the brain.
The observational study, published on November 5, 2025, in the medical journal Neurology, revealed that the risk of developing epilepsy after age 60 was approximately double for participants who had previously experienced a heart attack compared to those who had not. While the findings establish a strong association, the authors caution that they do not prove a direct cause-and-effect relationship. Researchers believe the connection lies in systemic vascular disease, a condition that can damage, block, or weaken blood vessels throughout the body, affecting both the heart and the brain simultaneously.
Tracing Health Over Decades
The findings emerged from a prospective cohort study that meticulously tracked the health of 3,174 adults for as long as 30 years. At the beginning of the research period, all participants were free of stroke, epilepsy, and had no history of heart attacks. The average age of the participants at enrollment was 69 years. This long-term approach allowed researchers to observe how health events earlier in life might influence neurological outcomes decades later.
Over the course of the study, 296 individuals experienced a heart attack. Separately, 120 participants were diagnosed with late-onset epilepsy, which the study defined as developing the seizure disorder after the age of 60. The comprehensive data collection allowed the research team to analyze the statistical relationship between these major health events while accounting for other life factors.
A Doubling of Epilepsy Risk
The study’s central finding is the stark difference in epilepsy rates between those who had a heart attack and those who did not. By analyzing the data over time, researchers calculated the incidence rate of the neurological disorder, providing a clear picture of the elevated risk.
Incidence Rates
The data showed a more than threefold increase in the rate of new epilepsy cases among heart attack survivors. Among the group that had experienced a heart attack, late-onset epilepsy developed at a rate of seven cases per 1,000 person-years. In contrast, for participants who never had a heart attack, the rate was just two cases per 1,000 person-years. “Person-years” is a metric that combines the number of people in the study with the amount of time each person participates, providing a robust measure of risk over time.
Adjusted Statistical Analysis
To ensure the link was not merely coincidental or caused by other health issues, the researchers adjusted for various confounding factors. After accounting for variables such as age, smoking history, and body weight, the analysis confirmed the strong association. The results showed that having a heart attack nearly doubled an individual’s likelihood of later developing late-onset epilepsy. This statistical adjustment strengthens the hypothesis that the connection between the two conditions is significant.
The Vascular Disease Connection
Researchers propose that the link is not a direct pathway from heart attack to epilepsy, but rather that both conditions may stem from a common underlying problem: widespread vascular disease. “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 study author Evan L. Thacker of Brigham Young University. This systemic issue can compromise blood flow and oxygen supply to vital organs.
According to this hypothesis, a heart attack serves as a major red flag for cerebrovascular disease—a condition specifically affecting the blood vessels supplying the brain. This underlying brain-vessel pathology, which may be silent for years, could be the actual trigger for the development of seizures and epilepsy later in life. The study did not find a significant reverse association; developing late-onset epilepsy did not appear to increase a person’s risk of having a future heart attack.
Epilepsy and Vascular Mortality
Further strengthening the vascular connection, the study uncovered a related and troubling pattern regarding mortality. Participants who developed late-onset epilepsy were found to have a substantially higher risk of dying from vascular causes other than stroke. After adjustments, these individuals were nearly three times more likely to die from a vascular cause compared to those who never developed epilepsy.
The rate of vascular deaths among people with late-onset epilepsy was 99 deaths per 1,000 person-years. This is dramatically higher than the rate of 16 deaths per 1,000 person-years observed in participants without epilepsy. These fatal vascular events included conditions such as heart failure, pulmonary embolism (a blood clot in the lungs), and aortic aneurysm. This finding suggests that a diagnosis of late-onset epilepsy may itself be a marker of advanced, systemic vascular disease.
Limitations and Clinical Implications
The study’s authors noted some limitations, including the observational nature of the research, which prevents the conclusion of direct causality. Additionally, the number of participants who experienced both a heart attack and later developed epilepsy was relatively small, which can make statistical estimates less precise. However, the findings provide a crucial new dimension to understanding brain health in older adults.
“These findings highlight the interconnectedness that heart and vascular health may have with brain health in later life,” Thacker stated. The research points to important clinical considerations for patient care after a cardiovascular event. “When an older adult has a heart attack, clinicians may want to stay alert for possible seizures later,” Thacker advised. This vigilance could lead to earlier diagnosis and management of epilepsy in a vulnerable and growing patient population.