Antiepileptic drugs and markers of vascular risk.
Antiepileptic drugs and markers of vascular risk.
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DOI：
10.1007/s11940-010-0080-y
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发表时间：
2010-07
影响因子：
2
通讯作者：
Mintzer, Scott
中科院分区：
文献类型：
--
作者：
LoPinto-Khoury, Carla;Mintzer, Scott
世界范围内最常用的癫痫治疗方法是旧一代药物，如苯妥英、卡马西平、苯巴比妥和丙戊酸，它们具有显著的酶促作用。然而，随着这些药物越来越多的潜在长期后果暴露出来，我们对这些治疗方法的舒适感开始消退。流行病学研究表明，心脑缺血性疾病在癫痫患者中更为常见。酶诱导药物与许多血管风险替代标志物的升高有关，表明它们可能是心脑血管疾病发病率增加的原因。酶抑制药物丙戊酸酯可能有其自身的有关葡萄糖和脂质代谢的不良后果。这些影响与文献中关于骨代谢、激素异常和药物-药物相互作用的研究结果一致。由于癫痫患者需要药物治疗数年，有时甚至终生，因此在有有效替代药物的情况下，很难证明长期使用这些药物是合理的。旧药物的许多副作用似乎可以迅速逆转，这促使人们考虑，即使没有明显的副作用，目前接受这些药物治疗的患者是否应该改用替代疗法。不影响肝酶的新药物可能没有这些慢性代谢后果，我们建议尽可能使用它们而不是老一代药物。
The most-used treatments for epilepsy worldwide are older-generation drugs such as phenytoin, carbamazepine, phenobarbital, and valproic acid, which have prominent enzymatic effects. Our sense of comfort with these treatments is starting to fade, however, as more and more potential long-term consequences of these drugs come to light. Epidemiologic studies demonstrate that ischemic disease of the heart and brain is more common among patients with epilepsy. Enzyme-inducing drugs are associated with elevations in a host of surrogate markers of vascular risk, suggesting that they could be responsible for increased rates of cardiovascular and cerebrovascular disease. The enzyme-inhibiting drug valproate may have adverse consequences of its own pertaining to glucose and lipid metabolism. These effects stand in addition to those well established in the literature regarding bone metabolism, hormonal abnormalities, and drug–drug interactions. Because patients with epilepsy require medication for years, and often for life, it is difficult to justify the long-term use of these agents when there are capable alternatives. Many of the adverse effects of the older drugs appear to be rapidly reversible, prompting consideration of whether patients who are currently treated with these agents should be switched to alternative therapies, even in the absence of obvious side effects. Newer medications without effects on hepatic enzymes likely do not have these chronic metabolic consequences, and we recommend their use over older-generation drugs whenever possible.
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影响因子：
8.3
作者：
Lorenz, MW;von Kegler, S;Sitzer, M
通讯作者：
Sitzer, M
影响因子：
120.7
作者：
Erqou, Sebhat;Kaptoge, Stephen;Perry, Philip L.;Di Angelantonio, Emanuele;Thompson, Alexander;White, Ian R.;Marcovina, Santica M.;Collins, Rory;Thompson, Simon G.;Danesh, John
通讯作者：
Danesh, John
影响因子：
1.9
作者：
Gibbons, GF
通讯作者：
Gibbons, GF
影响因子：
5.6
作者：
CALANDRE, EP;PORTA, BS;DELACALZADA, DG
通讯作者：
DELACALZADA, DG
影响因子：
2.9
作者：
LUOMA, PV;SOTANIEMI, EA;PIRTTIAHO, HI
通讯作者：
PIRTTIAHO, HI