Mortality from ischaemic heart disease among patients using anticonvulsive drugs: A case-control study

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Muuronen A, Kaste M, Nikkilä EA, and Tolppanen EM (1985) Mortality from ischaemic heart disease among patients using anticonvulsive drugs: A case-control study. Br Med J (Clin Res Ed) 291:6507 1481–3.

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Abstract: Patients who use phenytoin and some other anticonvulsive drugs have been shown to have raised concentrations of plasma high density lipoprotein. As this lipoprotein is known to be inversely associated with the incidence of ischaemic heart disease the causes of death of all patients with epilepsy known to be taking anticonvulsive drugs who died during 1978-80 were studied. Of 1399 deaths of anticonvulsant users, 258 (18.4%) were caused by ischaemic heart disease. This was significantly less (p less than 0.001) than the 382 deaths from ischaemic heart disease (27.3%) observed among paired controls matched for sex, age, and date of death. The total cardiovascular mortality was also lower among patients with epilepsy than among controls (p less than 0.02) despite there being more deaths due to cerebrovascular disease among patients. The difference in mortality from ischaemic heart disease was significant for both sexes and was not accounted for by excess deaths due to any other single cause. Users of phenytoin, carbamazepine, and barbiturates (alone or in combination) showed 29% less mortality due to ischaemic heart disease than respective controls (p less than 0.001).

Context

  • With the observed link between phenytoin and elevated HDL as rationale, the authors considered all deaths among epilepsy patients in Finland over 3 year period. Death from ischemic heart disease was significantly less common in epilepsy patients taking phenytoin and/or carbamazepine and/or barbiturates, and this difference was not due to excess epilepsy patient deaths from any other cause.

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