title: The effects of antiepileptic drugs on vascular risk factors: a narrative review.
abstract: OBJECTIVE
  Epilepsy is associated with increased cardiovascular disease (CVD) morbidity and mortality. The exact causes of this link are not clearly defined. The role of antiepileptic drugs (AEDs) in influencing CVD risk in patients with epilepsy remains controversial. A link between epilepsy, AEDs and cardiac arrhythmias has been proposed and may be responsible for sudden unexpected death in epilepsy (SUDEP).
  
  
  METHODS
  We searched MEDLINE up to December 1, 2013 for relevant publications using combinations of keywords. We also examined the reference list of articles identified by this search and selected those we judged relevant. These were included in this narrative review.
  
  
  RESULTS
  AEDs may exert both beneficial and adverse cardiovascular effects. This narrative review considers the influence of AEDs on some predictors of vascular risk [i.e. weight, insulin resistance, metabolic syndrome, lipids, lipoprotein (a), C-reactive protein, homocysteine, vitamins, coagulation factors, uric acid, carotid intima media thickness, markers of oxidative status and matrix metalloproteinase-9]. Certain AEDs can also have pro-arrhythmic properties.
  
  
  CONCLUSIONS
  AEDs may exert different effects on various established and emerging predictors of vascular risk. Furthermore, pharmacokinetic interactions between AEDs and drugs used to reduce vascular risk (e.g. statins) need to be better documented. Whether this knowledge, in terms of individualizing antiepileptic and CVD prevention treatment, will prove to be relevant in clinical practice remains to be established.
authors.affiliation: Department of Clinical Biochemistry (Vascular Disease Prevention Clinics), Royal Free Hospital Campus, University College London Medical School, University College London (UCL), London NW3 2QG, UK; Second Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki, Greece.
authors.forename: Niki
authors.initials: N
authors.lastname: Katsiki
authors.affiliation: Department of Clinical Biochemistry (Vascular Disease Prevention Clinics), Royal Free Hospital Campus, University College London Medical School, University College London (UCL), London NW3 2QG, UK.
authors.forename: Dimitri P
authors.initials: DP
authors.lastname: Mikhailidis
authors.affiliation: Department of Clinical Biochemistry (Vascular Disease Prevention Clinics), Royal Free Hospital, London NW3 2QG, UK. Electronic address: devaki.nair@nhs.net.
authors.forename: Devaki R
authors.initials: DR
authors.lastname: Nair
mesh_terms: D000818:Animals; D000927:Anticonvulsants / Q000009:adverse effects*; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000209:etiology / Q000401:mortality; D003645:Death, Sudden / Q000209:etiology; D004827:Epilepsy / Q000188:drug therapy / Q000453:epidemiology; D006801:Humans; D016239:MEDLINE / Q000706:statistics & numerical data; D012307:Risk Factors
chemical_list: D000927:Anticonvulsants
keywords: Cholesterol; Epilepsy treatment; Homocysteine; Risk; Vascular disease