Do antiepileptic drugs cause premature atherosclerosis by disturbing lipid metabolism?

Aim: The aim of this study was to evaluate susceptibility to atherosclerosis in epileptic patients on carbamazepine and valproic acid monotherapy with lipid profile, lipoprotein (a) (lp(a)), oxidized low-density lipoprotein (LDL), adiponectin, and carotid artery intima-media thickness measurements. Material and Methods: Of the 108 patients with epilepsy included in the study, 64 (36 female, 28 male) were receiving valproic acid monotherapy and 44 (25 female, 19 male) were receiving carbamazepine monotherapy. The control group comprised 48 (30 female, 18 male) healthy participants. Liver and kidney function tests, cholesterol, triglycerides, LDL, high-density lipoprotein (HDL), lp(a), oxidized LDL, adiponectin, and common carotid (CCA) and internal carotid artery (ICA) intima-media thickness (IMT) were investigated in both the patient and control groups. Results: Mean age was 32.34 +/- 12.41 years in the valproic acid group, 32.70 +/- 11.64 years in the carbamazepine group, and 35.81 +/- 11.76 years in the control group. Liver and kidney function test results were normal in all groups. Cholesterol levels were lower in the valproic acid group than the other groups. HDL levels were higher in the carbamazepine group than other groups. Adiponectin levels were lower in the valproic acid group. In all groups, cholesterol and LDL levels were higher in individuals older than 50 years old. When the patients were evaluated according to the duration of drug use, cholesterol and LDL levels were higher in patients who had used drugs for more than 5 years in the valproic acid group. There were no differences between the groups for triglyceride, oxidized LDL, or lp(a) levels or CCA and ICA IMT. Discussion: There are conflicting results in the literature regarding epilepsy and atherosclerosis associated with antiepileptic drug usage. In this study, no evidence was found of an increasing risk of arteriosclerosis associated with antiepileptic drugs by measuring lipids, lipoprotein, oxidized LDL, adiponectin levels, and CCA and ICA IMT. However, it is important to monitor lipid levels in the follow-up of patients with epilepsy, especially for patients requiring longterm antiepileptic therapy and also older patients.