Do males 30-50 years of age with chronic epilepsy and on long-term anticonvulsant medication have lower-than-expected risk of developing coronary heart disease?

PURPOSE: It has been claimed that long-term use of antiepileptic drugs (AEDs) brings about changes in the lipid profile which might resist development of cardiovascular disease. The aim of this study was to test the following hypothesis: Do males with chronic epilepsy and on long-term treatment with AEDs have a lower than expected risk of developing coronary heart disease? METHODS: The coronary risk profile in 40 male patients with chronic epilepsy, aged 30-50 years, was explored, using an American individual coronary risk factor test program (the Cooper test). We made a survey of the patients' risk factors: total cholesterol, high density lipoprotein (HDL) cholesterol, triglycerides, glucose, blood pressure, body fat percentage, physical fitness, hereditary factors, smoking habits, and degree of stress. Each factor was given a score, and the sum of scores constituted the total coronary risk profile. Eighty men in the same age group, casually selected from an industrial medical service, served as controls. RESULTS: There was no statistically significant difference in the total coronary risk profile between the epilepsy patients and the controls. Nor were there any significant differences among the individual risk factors except for physical fitness level, which was significantly lower among the epilepsy group than among the controls. In the epilepsy group, however, there was a trend toward higher levels of total cholesterol, higher levels of HDL-cholesterol, lower levels of total cholesterol/HDL-cholesterol ratio, increased body fat percentage, greater heredity and somewhat greater coronary risk score as compared with the healthy controls, but the differences did not reach statistical significance. The protective effect against coronary heart disease exercised by the enzyme-inducing AEDs seems to be counteracted by other factors, like reduced physical fitness and increased body fat percentage. CONCLUSIONS: Our hypothesis was not confirmed, because we found that the 40 patients with chronic epilepsy tested had about the same risk of developing coronary heart disease as did the control group.

[Low-calorie diet, exercise and hypertension. 2 pilot studies using a protein-rich low-calorie diet powder (Nutrilett)]. / Lavkaloridiett, mosjon og høyt blodtrykk. To pilotstudier med bruk av proteinrikt lavkaloridiettpulver (Nutrilett).

In the first study the physical performance in ten healthy overweight persons was assessed before and after a four week diet period. An exercise treadmill test (Bruce protocol) was used. No significant change in average oxygen uptake was found. Nine overweight men on antihypertensive treatment were put on the same diet, eight of them completed the study. The diet was well tolerated, and most of the men achieved better blood pressure control. In five of them the doses of antihypertensive medication could be reduced. The average weight loss was ten kilos in one group and eight kilos in the other. Since these were pilot studies with small numbers of participants, care should be taken in drawing general conclusions. The results are nevertheless promising, and we discuss the application of this regimen in patients in general practice.

Patient errors and preference with regard to the use of a bronchodilating spray and fenoterol (Berotec) powder.

The investigation compares the errors in using a bronchodilating spray and fenoterol powder for inhalation, it also determines the patient preference with regard to the preparation. Of 76 patients with obstructive lung disease, 15 (19, 7%) used the spray incorrectly, relatively many of them were elderly women. The most important cause was coordination problems. Only four had difficulty with the powder preparation. Forty-two patients preferred the spray providing the effects of both agents were equally good. Twenty-six preferred the powder and eight had no preference. The preference for powder was relatively greater among elderly women and among these patients who had not previously used a spray. It is concluded that the majority of earlier users of spray prefer this form of treatment and that instruction in the correct use of a spray is essential. The powder preparation is particularly advantageous for patients with coordination problems of various types.

A comparison of fenoterol powder capsules and fenoterol metered dose spray in bronchial asthma.

In the present investigation the effect of fenoterol powder for inhalation has been compared to that of fenoterol spray in 20 adult patients with reversible obstructive lung disease. No difference could be demonstrated between the two forms of the drug in a randomized cross-over study. Neither was it possible to demonstrate any difference between the two preparations following the use of the drug at home over a minimum of four days, with regard to daily PEF registration and symptom scores. Nine of the patients preferred spray, six powder.

A comparison of the plasma profiles of two slow-release theophylline preparations (Nuelin depot and Theo-dur) in healthy volunteers.

Fourteen healthy volunteers were given Theo-Dur or Nuelin Depot 250 mg b.i.d. in a cross-over study. Almost identical plasma concentrations of theophylline were found after both preparations, as assessed from plasma level measurements performed before intake and on several occasions up to 12 hours after intake of the ninth dose.

Individualization of oral theophylline dosage in elderly patients.

The present study is a prospective evaluation of a dosing nomogram for oral theophylline in 69 middle-aged and elderly patients (mean age 58.5 +/- 15.4 years) with obstructive lung disease. The main features of the nomogram were that the theophylline dose was increased in middle-aged as compared to old patients, and that smokers were always prescribed a higher dose than non-smokers of a similar age. The target theophylline concentration is presently defined as a trough level at steady state of 50 micromol/l. Approximately 50% of the patients achieved theophylline levels within +/- 20% of the target concentration, and none had theophylline levels exceeding 110 micromol/l. We conclude that the nomogram represents a useful guide in establishing a safe initial theophylline dose in this patient group.