Metabolic syndrome and anticonvulsants: A comparative study of valproic acid and carbamazepine

Rakitin, Aleksei; Kõks, Sulev; Haldre, Sulev

doi:10.1016/j.seizure.2016.03.008

Cited by 19 publications

(19 citation statements)

References 38 publications

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“…Despite this lack of statistical significance, the trend showing more hypertension in patients with structural and unknown etiology leads us to conclude that more studies are needed to clarify a finding that could be clinically relevant. (Rakitin et al, 2014) and did not differ from other AEDs such as CBZ in another report (Rakitin, Kõks, & Haldre, 2016). In our study, VPA had the lowest CRF PRc, and taking into account these recently published results, we considered that using it as the reference AED would not cause major confusion.…”

Section: Discussionsupporting

confidence: 58%

“…The choice of VPA as a reference AED is another potential limitation, as VPA has been associated with metabolic syndrome (Kim & Lee, 2007). More recent studies have called the association into question, as this trend was not replicable in a recent population study (Rakitin et al., 2014) and did not differ from other AEDs such as CBZ in another report (Rakitin, Kõks, & Haldre, 2016). In our study, VPA had the lowest CRF PRc, and taking into account these recently published results, we considered that using it as the reference AED would not cause major confusion.…”

Section: Discussionmentioning

confidence: 70%

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Prevalence of cardiovascular risk factors in people with epilepsy

et al. 2016

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ObjectivesEpilepsy has been associated with cardiovascular comorbidity. This study aimed to assess the potential association between cardiovascular risk factors (CRFs), antiepileptic drugs (AEDs), and etiology.Material and MethodsA single‐center retrospective epilepsy cohort from the decade of 2004–2013 was assessed. Poisson regression models with robust variance were estimated to obtain CRF prevalence ratios (PR) according to AED prescription and etiology.ResultsAfter excluding patients in the monotherapy group with vascular etiology or previous cardiovascular events, in the remaining 400 patients, enzyme‐inducer AEDs (EIAEDs), especially phenytoin (PHT), were associated with higher prevalence of dyslipidemia (PRa 1.77, p < .05), compared to valproic acid. No etiology was associated with higher prevalence of any CRF.ConclusionsPatients treated with EIAEDs, especially PHT, had higher prevalence of dyslipidemia.

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Section: Discussionsupporting

confidence: 58%

Section: Discussionmentioning

confidence: 70%

Prevalence of cardiovascular risk factors in people with epilepsy

et al. 2016

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“…MetS is defined as a cluster of metabolic risk factors that include central obesity, dyslipidemia, insulin resistance, and/or glucose intolerance, and abnormally high blood pressure, in variable associations that increases the risk to develop CVD and diabetes ( 9 ). The occurrence and relevance of MetS in patients with epilepsy has been gaining growing emphasis in the neurological literature ( 10 – 15 ). These studies are resumed in Table 1 , and they focused mainly on prevalence and metabolic aspects of MetS, but the definitions used were heterogeneous and data not readily comparable.…”

Section: Introductionmentioning

confidence: 99%

Diagnostic Yield and Accuracy of Different Metabolic Syndrome Criteria in Adult Patients with Epilepsy

et al. 2017

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IntroductionMetabolic syndrome (MetS) is an emergent problem among patients with epilepsy. Here, we evaluate and compare the diagnostic yield and accuracy of different MetS criteria among adult patients with epilepsy to further explore the best strategy for diagnosis of MetS among patients with epilepsy.Materials and methodsNinety-five epileptic adults from a tertiary epilepsy reference center were prospectively recruited over 22 weeks in a cross-sectional study. MetS was defined according to five international criteria used for the diagnosis of the condition [ATP3, American Association of Clinical Endocrinologists (AACE), International Diabetes Federation (IDF), AHA/NHLBI, and harmonized criteria]. Sensitivity, specificity, positive and negative predictive values (NPVs), and area under the receiver operating characteristic curve (ROC) curve were estimated for each criterion.ResultsIn our sample, adult patients with epilepsy showed a high prevalence of obesity, hypertension, and diabetes. However, the prevalence of MetS was significantly different according to each criterion used, ranging from 33.7%, as defined by AACE, to 49.4%, as defined by the harmonized criteria (p < 0.005). IDF criteria showed the highest sensitivity [S = 95.5% (95% CI 84.5–99.4), p < 0.05] and AACE criteria showed the lowest sensitivity and NPV [S = 68.2% (95% CI 52.4–81.4), p < 0.05; NPV = 75.8% (95% CI 62.3–86.1), p < 0.05]. ROC curve for all criteria studied showed that area under curve (AUC) for IDF criterion was 0.966, and it was not different from AUC of harmonized criterion (p = 0.092) that was used as reference. On the other hand, the use of the other three criteria for MetS resulted in significantly lower performance, with AUC for AHA/NHLBI = 0.920 (p = 0.0147), NCEP/ATP3 = 0.898 (p = 0.0067), AACE = 0.830 (p = 0.00059).ConclusionOur findings suggest that MetS might be highly prevalent among adult patients with epilepsy. Despite significant variations in the yield of different criteria, the harmonized definition produced the highest prevalence rates and perhaps should be preferred. Correct evaluation of these patients might improve the rates of detection of MetS and foster primary prevention of cardiovascular events in this population.

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“…However, this study lacked a control group of patients not taking VPA, and this result was similar to those reported in other studies carried out in obese patients who were not treated with VPA (21). Other researchers reported similar frequencies of MS between VPA-treated adults and control subjects (15, 23, 24). A study evaluating the prevalence of MS among Chinese adult obese patients with epilepsy treated with VPA showed a tendency toward a higher risk of MS compared to obese control subjects, without reaching the level of statistical significance (25).…”

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confidence: 53%