Antiseizure Meds and Cardiovascular Risk

This transcript has been edited for clarity.

Andrew N. Wilner, MD: Welcome to Medscape. I'm Dr Andrew Wilner, reporting from the virtual American Epilepsy Society annual meeting.

With me today is Dr Colin Josephson, assistant professor of neurology at the University of Calgary. Dr Josephson presented some very provocative data suggesting a relationship between enzyme-inducing antiseizure drugs and cardiovascular disease that I wanted to learn more about. Welcome, Dr Josephson.

Colin B. Josephson, MD: Thank you for having me. It's an absolute privilege to be here.

Wilner: What prompted your study? Let's start there.

Josephson: It's a good question. From population-based analyses, we know that cardiovascular risk factors such as hypertension, dyslipidemia, type 2 diabetes, and atrial fibrillation are more common at the time of diagnosis of adult-onset epilepsy than in age-matched peers. And when compared with the general population, we know that people with epilepsy have higher rates of ischemic heart disease, transient ischemic attack (TIAs), and hemorrhagic and ischemic strokes — anywhere from 1.5- to even 10-fold higher compared with their peers.

A systematic reviewsuggested that some of this risk may be attributable to the pro-atherogenic properties of the enzyme-inducing antiseizure medications. When I was a resident in the mid-2000s, it was a hotly debated question: whether this is a major risk factor to these medications.