Effect of Carbamazepine and Valproate Monotherapy on Cardiovascular Risks in Epileptic Children
Deepika Harit1, Anju Aggarwal1, Swati Kalra1
1Department of Pediatrics, University College of Medical Sciences and GTB Hospital, Delhi, India.
Insights
Long-term use of carbamazepine and valproic acid in epileptic children did not increase overall atherosclerosis risk. While valproic acid showed temporary increases in triglycerides and apolipoprotein B, key lipid ratios remained stable.
Area of Science:
- Pediatric Neurology
- Clinical Pharmacology
- Cardiovascular Risk Assessment
Background:
- Epilepsy affects children worldwide, necessitating long-term treatment with antiepileptic drugs (AEDs).
- Concerns exist regarding the potential cardiovascular impact of AEDs, specifically on lipid profiles.
- Carbamazepine and valproic acid are commonly prescribed for pediatric epilepsy.
Purpose of the Study:
- To investigate the effects of long-term monotherapy with carbamazepine and valproic acid on serum lipids and apolipoproteins in epileptic children.
- To assess lipid and apolipoprotein changes 3 months after discontinuation of these AEDs.
Main Methods:
- A cohort of 33 epileptic children (mean age 9.79 years) on carbamazepine (n=13) or valproic acid (n=20) monotherapy was studied.
- Serum lipid profiles and apolipoprotein A and B levels were measured at AED tapering initiation and 3 months post-cessation.
- Analysis focused on absolute lipid values and key lipid ratios indicative of atherosclerosis risk.
Main Results:
- Carbamazepine treatment showed no significant changes in lipid profiles or apolipoproteins during therapy or after discontinuation.
- Valproic acid treatment led to significant increases in triglycerides and apolipoprotein B 3 months after discontinuation.
- Despite some increases, the ratios of total cholesterol:high-density lipoprotein cholesterol improved, while low-density lipoprotein:high-density lipoprotein cholesterol and apolipoprotein B:apolipoprotein A ratios remained unchanged.
Conclusions:
- Long-term use of carbamazepine and valproic acid in epileptic children does not appear to elevate overall atherosclerosis risk.
- Improved lipid ratios, particularly total cholesterol to HDL cholesterol, suggest a neutral or potentially beneficial cardiovascular risk profile.
- Monitoring lipid profiles, especially after valproic acid discontinuation, may be warranted, although overall risk remains low.
Objective:
We determined the effects of carbamazepine and valproic acid on the serum lipids and apolipoprotein A and B in epileptic children on long-term monotherapy and 3 months after drug discontinuation.
Method:
Thirty-three epileptic children (17 boys, 16 girls, mean age 9.79 ± 2.5 years) were evaluated for serum lipids and lipoprotein results at the initiation of antiepileptic drug tapering and 3 months after cessation of antiepileptic therapy.
Results:
In the carbamazepine group (n = 13), there was no significant difference in the lipid profile at the end of therapy or at 3 months after the discontinuation, whereas in the valproate group (n = 20), triglycerides and apoprotein B and high-density lipoprotein cholesterol increased significantly 3 months after discontinuation. The ratios of total cholesterol:high-density lipoprotein improved but low-density lipoprotein:high-density lipoprotein and apolipoprotein:apolipoprotein remained unchanged.
Conclusion:
Because these ratios are better predictor of atherosclerosis risk than the absolute values, the overall risk is not increased by the long-term use of carbamazepine and valproate.
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