The Impact of Epilepsy, Antiepileptic Drugs, and Adjuvant Treatments on Subclinical Atherosclerosis: A Systematic Review and Meta-Analysis.
Yupeng Wu, Liu Yang, Xiaojiao Zhang et al.
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In 30 seconds
This systematic review and meta-analysis assessed associations of epilepsy, antiepileptic drugs (AEDs), and adjuvant treatments with subclinical atherosclerosis markers across 31 studies. Compared with controls, people with epilepsy had greater carotid intima-media thickness (cIMT; WMD [95% CI] = 0.063 [0.045-0.080], P < .001) and epicardial adipose tissue thickness, while flow-mediated vasodilation did not differ significantly. cIMT was also greater with old versus new AEDs, multiple versus single AEDs, and enzyme-inducing versus non-enzyme-inducing AEDs. Comparisons of the studied adjuvant treatments showed no significant cIMT differences.
Key findings
- Compared with controls, epilepsy was associated with greater cIMT (WMD [95% CI] = 0.063 [0.045-0.080], P < .001) and epicardial adipose tissue thickness (WMD [95% CI] = 1.985 [1.630-2.341], P < .001).
- Flow-mediated vasodilation did not differ significantly between people with epilepsy and controls (P > .050).
- cIMT was greater with old versus new AEDs (WMD [95% CI] = 0.038 [0.000-0.076], P = .050), multiple versus single AEDs (0.025 [0.021-0.029], P < .001), and enzyme-inducing versus non-enzyme-inducing AEDs (0.027 [0.006-0.047], P = .011).
- No significant cIMT differences were detected for ketogenic diet, Atkins diet, or folic acid supplementation comparisons (all P > .050).
Why it matters
The findings identify differences in structural markers of subclinical atherosclerosis among people with epilepsy and across AED regimens, although functional vascular findings were not significant. These markers may help frame cardiovascular risk assessment in this population. The results are associations from a synthesis of studies and do not establish that epilepsy or particular AEDs cause atherosclerosis.
What to keep in mind
The meta-analysis combines studies and outcomes, and the reported findings concern subclinical markers rather than clinical cardiovascular events; the abstract does not provide further detail on study quality or follow-up.