OBJECTIVES Several lines of evidence have suggested that exposure to enzyme-inducing antiseizure medications (EIASMs) may result in the subsequent development of hyperlipidemia, a well-known risk factor for vascular disease. This may be an issue of concern particularly in the context of additional comorbid vascular risk factors. We therefore aimed to investigate trends of and associations with the use of these medications among adult patients with epilepsy. METHODS The cross-sectional Medical Expenditure Panel Survey (MEPS) was interrogated to ascertain the prevalence of use of EIASMs by noninstitutionalized adult patients with epilepsy in the United States between the years 2004 and 2015. Any patient prescribed carbamazepine, phenytoin, phenobarbital, or primidone within a given year was defined as having been prescribed an EIASM. Trends over three-year epochs were evaluated with univariate logistic regression, while associations with demographic factors, vascular risk factors, and vascular disease were evaluated using a chi-square test corrected for survey design as well as multivariate logistic regression. RESULTS A total of 2281 (unweighted) patients were identified, representing 1,781,237 individuals. Between 2004 and 2015, 45.9% (95% confidence interval [CI]: 42.4%-49.4%) were prescribed EIASMs. Approximately one-quarter of patients aged 65 years and above used EIASMs compared with 18.5% of younger patients (odds ratio [OR]: 1.83, 95% CI = 1.27-2.65). Female patients (OR = 0.61, 95% CI = 0.47-0.79) and those with heart disease (OR: 0.63, 95% CI = 0.45-0.89) were significantly less likely to be prescribed EIASMs. Among those prescribed EIASMs, 38.9% had hypertension, 12.2% had diabetes, 61.6% were overweight or obese, 17.3% heart disease, 17.2% had a history of a cerebrovascular event, and 28.5% had diagnosed hyperlipidemia. Nonetheless, between 2004-2006 and 2013-2015, the odds of EIASM prescription decreased significantly (OR: 0.39, 95% CI: 0.28-0.55). CONCLUSIONS A substantial proportion of patients with comorbid vascular disease or vascular risk factors (e.g., hypertension and older age) is prescribed EIASMs. This could potentially increase patients' risk for subsequent negative outcomes such as cardiovascular or cerebrovascular disease. Though utilization of these medications has decreased, further efforts toward increasing use of newer antiseizure medications (ASMs) that are not associated with similar risks may be warranted.

中文翻译：

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酶诱导抗癫痫药物在癫痫和血管危险因素患者中的应用

目的 若干证据表明，暴露于酶诱导抗癫痫药物 (EIASM) 可能导致随后发生高脂血症，这是众所周知的血管疾病危险因素。这可能是一个值得关注的问题，特别是在其他合并血管危险因素的情况下。因此，我们旨在调查成年癫痫患者使用这些药物的趋势和相关性。方法 对横断面医疗支出小组调查 (MEPS) 进行了询问，以确定 2004 年至 2015 年期间美国非机构化成年癫痫患者使用 EIASM 的流行率。任何使用卡马西平、苯妥英、苯巴比妥或扑米酮的患者在给定的一年内被定义为已被规定了 EIASM。使用单变量逻辑回归评估三年时期的趋势，同时使用针对调查设计校正的卡方检验以及多变量逻辑回归评估与人口统计学因素、血管危险因素和血管疾病的关联。结果 共确定了 2281 名（未加权）患者，代表 1,781,237 个人。2004 年至 2015 年间，45.9%（95% 置信区间 [CI]：42.4%-49.4%）接受了 EIASM。大约四分之一的 65 岁及以上患者使用 EIASM，而年轻患者为 18.5%（优势比 [OR]：1.83，95% CI = 1.27-2.65）。女性患者 (OR = 0.61, 95% CI = 0.47-0.79) 和心脏病患者 (OR: 0.63, 95% CI = 0.45-0.89) 使用 EIASM 的可能性显着降低。在那些规定的 EIASM 中，38.9% 患有高血压，12.2% 患有糖尿病，61.6% 超重或肥胖，17.3% 心脏病，17.2% 有脑血管事件史，28.5% 诊断为高脂血症。尽管如此，在 2004-2006 和 2013-2015 之间，EIASM 处方的几率显着下降（OR：0.39，95% CI：0.28-0.55）。结论 很大一部分患有合并血管疾病或血管危险因素（例如高血压和年龄较大）的患者接受了 EIASM。这可能会增加患者发生心血管或脑血管疾病等后续负面结果的风险。虽然这些药物的使用已经减少，但可能需要进一步努力增加使用与类似风险无关的新型抗癫痫药物 (ASM)。2% 有脑血管事件史，28.5% 诊断为高脂血症。尽管如此，在 2004-2006 和 2013-2015 之间，EIASM 处方的几率显着下降（OR：0.39，95% CI：0.28-0.55）。结论 很大一部分患有合并血管疾病或血管危险因素（例如高血压和年龄较大）的患者接受了 EIASM。这可能会增加患者发生心血管或脑血管疾病等后续负面结果的风险。虽然这些药物的使用已经减少，但可能需要进一步努力增加使用与类似风险无关的新型抗癫痫药物 (ASM)。2% 有脑血管事件病史，28.5% 诊断为高脂血症。尽管如此，在 2004-2006 和 2013-2015 之间，EIASM 处方的几率显着下降（OR：0.39，95% CI：0.28-0.55）。结论 很大一部分患有合并血管疾病或血管危险因素（例如高血压和年龄较大）的患者接受了 EIASM。这可能会增加患者发生心血管或脑血管疾病等后续负面结果的风险。虽然这些药物的使用已经减少，但可能需要进一步努力增加使用与类似风险无关的新型抗癫痫药物 (ASM)。EIASM 处方的几率显着降低（OR：0.39，95% CI：0.28-0.55）。结论 很大一部分患有合并血管疾病或血管危险因素（例如高血压和年龄较大）的患者接受了 EIASM。这可能会增加患者发生心血管或脑血管疾病等后续负面结果的风险。虽然这些药物的使用已经减少，但可能需要进一步努力增加使用与类似风险无关的新型抗癫痫药物 (ASM)。EIASM 处方的几率显着降低（OR：0.39，95% CI：0.28-0.55）。结论 很大一部分患有合并血管疾病或血管危险因素（例如高血压和年龄较大）的患者接受了 EIASM。这可能会增加患者发生心血管或脑血管疾病等后续负面结果的风险。虽然这些药物的使用已经减少，但可能需要进一步努力增加使用与类似风险无关的新型抗癫痫药物 (ASM)。后续负面结果的风险，例如心血管或脑血管疾病。虽然这些药物的使用已经减少，但可能需要进一步努力增加使用与类似风险无关的新型抗癫痫药物 (ASM)。后续负面结果的风险，例如心血管或脑血管疾病。虽然这些药物的使用已经减少，但可能需要进一步努力增加使用与类似风险无关的新型抗癫痫药物 (ASM)。