Risk of heart attack with antiepileptics of small clinical relevance on population level

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Some antiepileptic drugs (AEDs), such as phenytoin induce liver enzymes, increasing lipid levels — a risk factor for heart attack and stroke. In contrast, the AED sodium valproate is a liver enzyme inhibitor and other, newer AEDs have a negligible effect. 

Researchers used the UK Clinical Practice Research Datalink to compare patients newly prescribed different classes of antiepileptic drugs between 1990 and 2013 (n=252,407). Inducing drugs slightly increased the risk of ischaemic stroke compared with non-inducing AEDs (relative risk [RR]=1.16, 95% confidence interval [CI] 1.02 to 1.33) and when taken for two years or longer increased the risk of myocardial infarction by 46% (RR=1.46, 95% CI 1.15 to 1.85). Inhibiting AEDs slightly decreased myocardial infarction risk (RR=0.81, 95% CI 0.66 to 1.00). 

Overall, the increased risk of myocardial infarction is most likely of small clinical relevance on a population level, the authors say in BMJ Open (online, 12 August 2015)[1]
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References

 [1]  Renoux C, Dell’Aniello S, Saarela O et al . Antiepileptic drugs and the risk of ischaemic stroke and myocardial infarction: a population-based cohort study. BMJ Open 2015. doi:10.1136/bmjopen-2015-008365.

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Citation
The Pharmaceutical Journal, PJ, 5 September 2015, Vol 295, No 7878;295(7878):DOI:10.1211/PJ.2015.20069242