ABSTRACT
OBJECTIVE: Evaluate if eslicarbazepine acetate (ESL) in combination with other non-inducer antiepileptic drugs (AEDs) in the treatment of epilepsy may represent a positive impact in the cardiovascular risk profile. METHODS: multicentre, retrospective, observational, non-interventional, real-life study comparing patients treated with cytochrome P450 (CYP) inducer vs. ESL plus non-inducer AEDs. Primary endpoint: Carotid intima-media thickness (CIMT) measured following the Manheim Consensus criteria. RESULTS: Patients included: 163. The main demographic, clinical and vascular risk parameters were comparable between the two groups except for duration of the disease, prevalence of dyslipidemia and use of lipid-lowering drugs (significantly higher in the inducers group) and number of previous antiepileptic drugs (significantly higher in the non-inducers group). Bivariate analysis of the main endpoint showed almost significant differences (p=0.05) in CIMT measures favourable to non-inducers (average 0.617mm+SD=0.148) vs. inducers (average 0.663mm+SD=0.147). Other variables reaching statistical significance were: age >50 years (p<0.001), high blood pressure (p<0.01) and dyslipidemia (p<0.05). A multivariate analysis including these variables and biochemical vascular risk factors showed a predictor model including two variables: inducers group (p=0.031; Coefficient ß=0.234) and age >50 years (p=0.001; Coefficient ß=0.387). Regarding gender, the mean CIMT in males was significantly higher in the inducers (0.693mm; SD=0.139) than in the non- inducers groups (0.628mm; SD=0.151; p<0.05). In females the differences were not significant. SIGNIFICANCE: The use of CYP inducer AEDs is associated with a significant increase in CIMT as compared with ESL and other non-inducer AEDs. The study shows a decrease in the vascular risk measured by ultrasound criteria in male patients treated with ESL compared with patients treated with inducer AEDs.
Subject(s)
Carotid Intima-Media Thickness , Dibenzazepines/therapeutic use , Epilepsies, Partial/drug therapy , Epilepsies, Partial/pathology , Voltage-Gated Sodium Channel Blockers/therapeutic use , Adolescent , Adult , Aged , Epilepsies, Partial/complications , Female , Humans , Hypertension/etiology , Male , Middle Aged , Retrospective Studies , Statistics, Nonparametric , Ultrasonography , Young AdultABSTRACT
Hypertension represents a relative risk of stroke up to 5 times. It is associated to ischaemic and haemorrhagic stroke. Hypertension produces an increase in brain vessels resistance and loss of the physiological mechanism of autoregulation, and it can be measured with transcranial doppler. Clinical trials have established that reducing blood pressure is effective in primary prevention of ischaemic and haemorrhagic stroke in hypertensive patients and in secondary prevention in hypertensive and non-hypertensive patients, even with small reductions in blood pressure. There is no evidence of superiority of a definite drug, although drugs that have proven efficacy in clinical trials are recommended in clinical practice.
Subject(s)
Antihypertensive Agents/therapeutic use , Hypertension/drug therapy , Stroke/prevention & control , Clinical Trials as Topic , Humans , Hypertension/physiopathology , Stroke/etiologyABSTRACT
La hipertensión arterial representa un riesgo relativo de ictus cerebral de hasta 5 veces. Se asocia tanto al infarto como a la hemorragia cerebral. En el lecho vascular cerebral produce aumento de las resis-tencias vasculares cerebrales y pérdida del mecanismo fisiológico de autorregulación cerebral, que pueden medirse mediante Doppler transcraneal. Los ensayos clínicos han establecido que la reducción de la presión arterial es efectiva en la prevención primaria de ictus isquémico y hemorrágico en individuos hipertensos, y en prevención secundaria del ictus en individuos hipertensos o no, incluso con pequeñas reducciones de las cifras. No existe evidencia de la superioridad de un fármaco en particular, aunque en la práctica clínica se recomiendan aquellos que han demostrado eficacia en los ensayos clínicos
Hypertension represents a relative risk of stroke up to 5 times. It is associated to ischaemic and haemorrhagic stroke. Hypertension produces an increase in brain vessels resistence and loss of the physiological mechanism of autoregulation, and it can be measured with transcranial doppler. Clinical trials have established that reducing blood pressure is effective in primary prevention of ischaemic and haemorrhagic stroke in hypertensive patients and in secondary prevention in hypertensive and non-hypertensive patients, even with small reductions in blood pressure. There is no evidence of superiority of a definite drug, although drugs that have proven efficacy in clinical trials are recommended in clinical practice
Subject(s)
Humans , Antihypertensive Agents/therapeutic use , Hypertension/complications , Hypertension/drug therapy , Stroke/etiology , Stroke/prevention & control , Clinical Trials as Topic , Hypertension/physiopathology , Stroke/physiopathologyABSTRACT
Introducción. Determinados estudios en cardiopatía isquémica han mostrado una reducción de la pravastatina en la prevención del ictus. En espera de los ensayos clínicos apropiados, se discute el posible papel terapéutico de estos fármacos en este subgrupo de pacientes. Desarrollo. Un panel de expertos multidisciplinar evalúan los datos existentes sobre el papel de las dislipemias en la epidemiología de los ictus, la posible acción de las estatinas en la prevención del infarto cerebral y en pacientes con estenosis de carótida de origen ateromatoso, así como su mecanismo de acción. Conclusiones. La pravastatina estaría indicada en todos los pacientes con ictus de origen ateromatoso como prevención primaria de la cardiopatía isquémica, en pacientes con ictus e hipercolesterolemia y en pacientes con estenosis carotídea, sintomática y asintomática, en espera de los ensayos clínicos específicos (AU)
