Abstract Details

Title Lipid Alterations with Antiepileptic Drugs: A Meta-Analysis of Their Cardiovascular Risk Potential

Topic Epilepsy/Clinical Neurophysiology (EEG)

Presentation(s) P9 - Poster Session 9 (5:00 PM-6:00 PM)

Poster/Presentation
Number 11-009

Objective This study systematically assessed the effects of commonly used AEDs on serum lipid fractions and evaluated their comparative cardiovascular risk using data from observational studies.

Background

Long-term antiepileptic drug (AED) therapy significantly affects lipid metabolism, altering cholesterol, triglyceride, and low-density lipoprotein (LDL) levels that contribute to atherosclerosis and elevated cardiovascular risk in epilepsy patients. Recognizing and managing AED-induced dyslipidemia is essential for optimizing long-term cardiovascular health in epilepsy care.

Design/Methods

A comprehensive search was conducted in PubMed, Google Scholar, Embase, and ClinicalTrials.gov (2000–October 2025) following PRISMA guidelines. After deduplication (n = 26,091), 27 full-text articles were reviewed, and 15 observational studies were included. Network meta-analysis, P-score ranking, forest plots, and heterogeneity measures (Q, I², τ²) were applied to quantify and compare lipid alterations associated with different AEDs.

Results Forest plot analyses indicated that carbamazepine, phenytoin, and phenobarbital consistently and significantly increased LDL (mean differences: +27.76, +17.12, and +26.47 mg/dL, respectively) and total cholesterol (+35.49, +23.18, and +29.31 mg/dL, respectively). Valproate and carbamazepine also significantly raised triglycerides (+13.31 mg/dL and +21.04 mg/dL, respectively). Levetiracetam, topiramate, and oxcarbazepine showed minimal, non-significant changes. Lamotrigine most effectively lowered LDL (P-score 0.90), total cholesterol (0.97), and VLDL (0.84); oxcarbazepine lowered triglycerides (0.75), and phenytoin raised HDL (0.89). Heterogeneity likely reflects population and study differences but highlights consistent AED-associated lipid patterns.

Conclusions

Enzyme-inducing AEDs substantially elevate atherogenic lipids, increasing cardiovascular risk, whereas newer AEDs, particularly lamotrigine, demonstrate neutral or favorable lipid effects. These findings support individualized AED prescribing, favoring newer agents and routine lipid checks for those at cardiovascular risk, to reduce long-term complications. Further research should clarify mechanisms and optimize cardiac safety in epilepsy care.

Authors/Disclosures
Anshum Patel PRESENTER	Dr. Patel has nothing to disclose.
Gurleen Kaur, MBBS	Dr. Kaur has nothing to disclose.
Farheen F. Vhora, MBBS	Dr. Vhora has nothing to disclose.
Nieraj Jain	The institution of Dr. Jain has received research support from Foundation Fighting Blindness. The institution of Dr. Jain has received research support from Janssen . The institution of Dr. Jain has received research support from SpliceBio. The institution of Dr. Jain has received research support from MeiraGTx. The institution of Dr. Jain has received research support from Ocugen Inc.
Suleman Shah, RN	Mr. Shah has nothing to disclose.
Abhisek Sahoo	Abhisek Sahoo has nothing to disclose.
King David Oware, MBChB, MPH	Dr. Oware has nothing to disclose.
Mihir H. Sojitra, MD	Dr. Sojitra has nothing to disclose.
Arkansh Sharma	Mr. Sharma has nothing to disclose.
Nidhi H. Vadhavekar, MBBS	Dr. Vadhavekar has nothing to disclose.

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