Comparison of the Metabolic Syndrome Risk in Valproate-Treated Patients with Epilepsy and the General Population in Estonia

Abstract

BackgroundNo study has explored the risk of metabolic syndrome (MS) in patients with epilepsy treated with valproate (VPA) at the population level. The aim of this study was to compare the risk of MS in VPA-treated patients in Estonia to the risk in the general population.MethodsThis study involved 118 patients with epilepsy (63 men, 55 women) who received VPA monotherapy. MS was diagnosed according to the National Cholesterol Education Program Adult Treatment Panel III criteria. Data were compared with the results of a population-based study of the prevalence of MS in the same geographic region (N = 493; 213 men, 280 women).ResultsIn the multiple logistic regression analysis, after adjustment for age and sex, the risk of MS in VPA-treated patients was not increased compared to the control subjects (odds ratio [OR] = 1.00; 95% confidence interval [CI], 0.59–1.68). VPA-treated patients had higher serum insulin concentrations than control subjects, independent of body mass index (BMI). A positive association was found between MS development and BMI (OR = 1.47; 95% CI, 1.25–1.73) in VPA-treated patients, but there were no associations with the VPA dosage or the homeostasis model assessment-estimated insulin resistance (HOMA-IR) index. In control subjects, BMI and HOMA-IR had similar predictive abilities for MS occurrence. In VPA-treated patients, the predictive ability of the HOMA-IR index was significantly lower than that of BMI, with areas under the receiver operating characteristic curves of 0.808 and 0.897 (P = 0.05), respectively.ConclusionsThe risk of MS is not increased among VPA-treated patients with epilepsy in Estonia compared to the general population. The HOMA-IR index likely has a lower predictive ability for MS in VPA-treated patients compared to its predictive ability in the general population.

Prevalence of cardiovascular risk factors in people with epilepsy

“…Despite this lack of statistical significance, the trend showing more hypertension in patients with structural and unknown etiology leads us to conclude that more studies are needed to clarify a finding that could be clinically relevant. (Rakitin et al, 2014) and did not differ from other AEDs such as CBZ in another report (Rakitin, Kõks, & Haldre, 2016). In our study, VPA had the lowest CRF PRc, and taking into account these recently published results, we considered that using it as the reference AED would not cause major confusion.…”

Frequency of metabolic syndrome and insulin resistance in epileptic patients treated with sodium valproate or carbamazepine monotherapy: A Case-Control Study

“…The aim of this study was to determine whether treatment with VPA or CBZ is correlated with MetS development and risk of IR in epileptic patients. The ndings of our study showed that, VPA treatment approximately increased the risk of MetS based on IDF criteria 19 times more than the control, There are several studies conducted on the signi cant effect of VPA on the development of MetS [2,12,13,36] Rakitin et al reported that, the risk of MetS did not increase in 118 epileptic patients who received the VPA as monotherapy [1]. The NCEP criteria was used for evaluation of MetS risk in Rakitin's study.…”

“…On the other hand, CBZ therapy showed signi cant correlation with IR risk based on HOMA index only. Most studies have used the HOMA index, and they have reported signi cantly increased values of IR in VPA-treated cases [1,2,36,48]. However, Naja et al [19] studied the VPA-treated Iranian patients and they reported that there were normal values of insulin and no evidence of IR in VPA-treated as case and CBZ -treated as controls and this nding has also been supported by a study conducted by Kwan et al [49].…”

“…Epilepsy is one of the most prevalent neurological illnesses, especially in young children and old age people of both males and females in all races. Among the antiepileptic drugs (AEDs), Valproate (VPA) and Carbamazepine (CBZ) are more frequently used for both epileptic and non-epileptic purposes such as bipolar syndrome and migraine prophylaxis [1,2]. Many patients may be need long duration of treatment therefore, understanding the safety of the drugs is important for patients and neurologist.…”

Does Valproic Acid Have Potential in the Treatment of Diabetes Mellitus?

“…However, this study lacked a control group of patients not taking VPA, and this result was similar to those reported in other studies carried out in obese patients who were not treated with VPA ( 21 ). Other researchers reported similar frequencies of MS between VPA-treated adults and control subjects ( 15 , 23 , 24 ). A study evaluating the prevalence of MS among Chinese adult obese patients with epilepsy treated with VPA showed a tendency toward a higher risk of MS compared to obese control subjects, without reaching the level of statistical significance ( 25 ).…”