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Narcolepsy and CV Risk
Why Are Patients With Narcolepsy at Increased Cardiovascular Risk?

Released: April 25, 2024

Expiration: April 24, 2025

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Key Takeaways
  • Patients with narcolepsy are at increased risk of cardiovascular comorbidities such as heart attack, stroke, and hypertension.
  • Treatment initiation with high-sodium oxybate increases the risk for new-onset hypertension. 
  • Healthcare professionals should consider aggressive cardiovascular risk factor modification to mitigate patients’ heightened cardiovascular risk.

Studies show that patients with narcolepsy have an increased cardiovascular risk, including heart attack, stroke, and hypertension. In the cross-sectional BOND study of people with narcolepsy (n = 9312) compared with matched controls (n = 46,559) using 5 years of administrative insurance claims data, results showed that those with narcolepsy experienced a 2-fold increase in healthcare utilization, including inpatient admissions and emergency department and outpatient visits.

Subsequently, the CV-BOND study, again using administrative insurance claims data, sought to build upon these earlier findings to determine whether patients with narcolepsy were at increased risk for new-onset cardiovascular events. Data from patients with narcolepsy (n = 12,816) and matched controls without narcolepsy (n = 38,441) were included in this study, which confirmed an overall higher prevalence of baseline comorbidities in patients diagnosed with narcolepsy. Specifically, diabetes, obesity, hyperlipidemia, and prior cardiovascular disease (CVD) were some of the comorbidities that were more prevalent among patients with narcolepsy. Furthermore, the likelihood of patients having new-onset comorbid heart failure, stroke, major adverse cardiac events, or CVD was significantly increased compared with their matched controls. Adjustments made in this analysis were for age, sex, region, insurance type, and relevant comorbidities.

Finally, another study of 320 patients with narcolepsy found that this population has a CVD prevalence that is twice as high as that noted in controls from a matched general population.  

Pharmacotherapy for Narcolepsy and Increased Cardiovascular Risk
The role of medications in increased cardiovascular risk remains to be fully defined. Wake-promoting agents used to treat narcolepsy may increase one’s blood pressure, and some narcoleptic medications contain high levels of sodium, which also may contribute to hypertension incidence. Indeed, recent data from an administrative claims analysis suggest that those with narcolepsy initiating treatment with high-sodium oxybate face an increased risk of new-onset hypertension (defined by a new-onset diagnosis or administration of antihypertensive medications) compared with those not being treated with high-sodium oxybate. In addition, this increased risk was evident among those without a history of CVD.  

The mechanisms underlying this increased prevalence and incidence of CVD among patients with narcolepsy need to be better understood. For example, factors such as short sleep duration, poor sleep quality, and excessive daytime somnolence may be implicated, as may orexin abnormalities, particularly in those with narcolepsy type I. From a blood pressure perspective, the normal reduction of blood pressure during sleep may be impaired because these patients are more likely to have a nondipping blood pressure profile. There are compelling data that link nondipping blood pressure patterns to an increased overall cardiovascular risk. Therefore, all the data discussed here strongly suggest that healthcare professionals should consider aggressive cardiovascular risk factor modification to mitigate patients’ evident and heightened cardiovascular risk. 

Your Thoughts?
In treating patients with narcolepsy, have you modified their treatment to address an increased cardiovascular risk? Get involved in the conversation by answering the polling question and posting a comment below.

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In treating patients with narcolepsy, have you modified their treatment to address an increased cardiovascular risk?

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