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首页> 外文期刊>Epilepsia: Journal of the International League against Epilepsy >Impact of carbamazepine, lamotrigine, and levetiracetam on vascular risk markers and lipid‐lowering agents in the elderly
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Impact of carbamazepine, lamotrigine, and levetiracetam on vascular risk markers and lipid‐lowering agents in the elderly

机译：Carbamazepine，Lamotrigine和Levetiracetam对老年人血管风险标志物和降脂剂的影响

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Summary Objective To examine serologic markers of vascular risk under treatment with commonly used antiepileptic drugs ( AED s) in the elderly in a randomized setting, and to determine whether the reduced exposure to hydroxymethylglutaryl‐CoA reductase inhibitors (“statins”) caused by carbamazepine reduces the effectiveness of the drugs as lipid‐lowering agents. Methods Standard lipid fractions, lipoprotein(a), and C‐reactive protein ( CRP ) were examined in a subset of those participating in the STEP ‐ ONE trial, in which elderly patients with new epilepsy were randomized to treatment with carbamazepine, lamotrigine, or levetiracetam. Separate comparisons were made by individual AED , among those treated with statins, and, for CRP , among those treated with anti‐inflammatory drugs. Results One hundred ninety‐four patients had the aforementioned serologic measurements. In patients not taking statins, those treated with carbamazepine had higher total cholesterol than those treated with levetiracetam (+16.6 mg/dL, P = 0.053), with values from patients on lamotrigine intermediate, whereas cholesterol fractions were subject to drug–gender interactions which did not show a consistent pattern. Lipoprotein(a) was significantly lower in lamotrigine patients than in the carbamazepine and levetiracetam groups. After accounting for the effects of steroids, CRP was higher in carbamazepine patients than in other patients. Patients taking a statin had lower lipid levels than those not taking a statin regardless of AED , but the differences between statin‐treated and non–statin‐treated patients were much larger (50%‐100% or more) in the lamotrigine and levetiracetam groups than in the carbamazepine group ( P = 0.035 for interaction effect of statin use and AED on total cholesterol). Significance Here, we demonstrate that carbamazepine significantly interferes with the ability of statins to lower total cholesterol, thus making it a poor choice for hyperlipidemic patients or those with cardiovascular disease. Native AED effects on lipids were inconsistent and subject to drug–gender interaction, in contrast with other studies; further investigation is necessary to determine if these latter findings are genuine or spurious.
机译：概述目的探讨在随机设置中常用的抗癫痫药物（AED S）治疗血管风险的血管风险的血管血管学标志物，并确定由Carbamazepine引起的羟甲基戊族核酸CoA还原酶抑制剂（“他汀类药物”）的暴露降低药物作为脂质降低剂的有效性。方法在参与阶跃试验的那些子集中检查标准脂分，脂蛋白（A）和C反应蛋白（CRP），其中患有新癫痫的老年患者随机用卡吡嗪，甲噻嗪或Levetiracetam。单独的比较由个体AED，其中用他汀类药物治疗的人，以及用于抗炎药物治疗的人。结果百九十四名患者具有上述血清学测量。在没有服用他汀类药物的患者中，用尿嘧啶（+ 16.6mg / dl，p = 0.053）处理的总胆固醇的总胆固醇具有更高的总胆固醇，具有来自乳甲中间体的患者的价值，而胆固醇级分受药物 - 性别相互作用的影响没有显示一致的模式。脂蛋白患者脂蛋白（A）显着低于胭脂红嗪和左旋虫蛋白组。在核算类固醇的效果后，CRP患者患者比其他患者更高。服用他汀类药物的患者脂质水平低于不服用的脂质水平，无论AED如何，但他汀类药物治疗和非他汀类药物治疗的患者之间的差异在拉米嗪和Levetiracetam组中的较大（50％-100％或更多）而不是在卡巴马嗪类（P = 0.035中，用于他汀类药物使用和总胆固醇的相互作用）。这里的意义，我们证明群毒素显着干扰他汀类药物降低总胆固醇的能力，从而使其对高脂血症患者或具有心血管疾病的患者的选择性差。与其他研究相比，本土对脂质的脂质效果不一致并受药物性别相互作用的影响;需要进一步调查，以确定后一种结果是真实还是虚假的。

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