Patients With Narcolepsy at Higher Risk for New-Onset Cardiovascular Events

Individuals with narcolepsy have a higher risk for new-onset cardiovascular events, including any stroke, heart failure, ischemic stroke, and more.

An increased risk for new-onset cardiovascular (CV) events was seen among individuals with narcolepsy, compared with those without narcolepsy, according to study results published in Sleep.

Although previous research has shown an association between narcolepsy and CV risk factors, limited evidence is available on the risk for new-onset CV events among patients with narcolepsy. Further understanding of this risk may inform treatment decisions.

Therefore, researchers of a real-world study aimed to evaluate the excess risk for new-onset CV events among US adults with narcolepsy.

Using the IBM® MarketScan® database, adult patients with at least 2 outpatient visits involving a narcolepsy diagnosis were identified between 2014 and 2019. The patient cohort was age- and sex-matched 1:3 with a non-narcolepsy control cohort.

Physicians should consider cardiovascular risk in patients with narcolepsy when weighing treatment options.

Participants were followed-up with until their medical insurance was discontinued, occurrence of an outcome of interest, or end of the data collection period.

Outcomes of interest included CV events, such as stroke, atrial fibrillation (AF), heart failure (HF), ischemic stroke, major adverse cardiac events (MACEs), and myocardial infarction (MI).

A total of 12,816 patients with narcolepsy and 38,441 of those without narcolepsy were included in the study.

Baseline comorbidities, such as sleep apnea, hypersomnia, and mood and anxiety disorders, were more frequently observed among participants with vs without narcolepsy.

Compared with the non-narcolepsy group, the narcolepsy group had higher crude incidence rates per 1,000 person-years for CV outcomes (P <.05 except for MI), including stroke (17.7 vs 8.9), CV disease (CVD; 13.3 vs 8.0), and MACEs (11.8 vs 6.9).

The researchers noted an increased risk for new-onset CV events among patients with narcolepsy vs control participants. The CV events included stroke (adjusted hazard ratio [HR], 1.71), HF (HR, 1.35), ischemic stroke (HR, 1.67), and MACEs (HR, 1.45), as well as grouped instances of stroke, AF, or edema (HR, 1.48), and CVD (HR, 1.30).

Limitations of the study included the lack of generalizability to those without insurance or those outside the US; the possible overestimation of incidence rates due to prevalent conditions; and the lack of adjusting for certain variables, including disease duration, hypocretin levels, and body weight, which may have increased CV risk among patients with narcolepsy.

The researchers concluded, “Physicians should consider cardiovascular [CV] risk in patients with narcolepsy when weighing treatment options.”

Disclosure: This research was supported by Jazz Pharmaceuticals. Multiple study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.


Ben-Joseph RH, Saad R, Black J, et al. Cardiovascular burden of narcolepsy disease (CV-BOND): a real-world evidence study. Sleep. Published online June 12, 2023. doi:10.1093/sleep/zsad161