Abstracts

Elevated serum homocysteine (s-Hcy) is recognized as an independent risk factor in premature coronary disease. Furthermore, epidemiological studies have found ischemic heart disease is increased by 20% and fatal cardiovascular disease (CVD) is three times higher in patients with epilepsy. The incidence of cerebrovascular accident in epilepsy populations is estimated to be two to six times that of the normal population. Anti-epileptic drugs (AEDs) have been shown to increase s-Hcy by lowering blood folate levels. The goal of this study was to examine homocysteine and other cardiovascular risk factors in epilepsy. We screened 405 clinic charts over the past 2 years to identify 120 subjects with CVD assessment including: age, gender, seizure type, years on AEDs, s-Hcy, serum folic acid (s-FA), lipids, glucose, blood pressure, weight, smoking and alcohol consumption, body mass index (BMI) and vitamin use patterns. This was an adult epilepsy population: mean age (SD) was 44 years (14), range 17 to 81, there were 51 males and 69 females. Fifty were African American, 46 Caucasian, 20 Latino and 3 Asian/Other, average length of AED exposure was 26 years (SD = 14.8, range 2 to 64). Average homocysteine levels in micromol/L (SD) were 11.3 (7.6) for African Americans, 12.5 (8.3) for Latinos, 9.4 (4.1) for Caucasians and 6.8 (0.8) for Asian/Other. Homocysteine was inversely correlated with s-FA (n = 89; Pearson[apos]s r = -0.41, p = .000). Fifteen percent of subjects had s-Hcy levels [gt] 15 micromol/L a concentration that is associated with a three-fold increase in myocardial infarction and a two-fold increased risk in carotid stenosis. Mean body weight was 174 lbs. (SD = 43.21). All four ethnicities had average BMI considered overweight based on National Institutes of Health guidelines. BMI was positively correlated with total cholesterol (n = 79; Pearson[apos]s r = 0.347, p = .002) and with LDL cholesterol (n = 74; Pearson[apos]s r = 0.321, p = .005). Mean total cholesterol (SD) was 197 mg/dl (39) and mean HDL (SD) 61 mg/dl (21) were within optimal ATP III guidelines. Mean LDL cholesterol (SD) was 113 mg/dl (34) which is considered above optimal. Eleven patients took statins. Mean blood pressure (SD) was 129/79 mmHg (18/11) which is in the pre-hypertensive range according to the revised JNC 7 guidelines. Twenty five patients received medication for hypertension. Phenytoin, phenobarbital, primidone, carbamazepine, valproic acid and lamotrigine are known folate antagonists. Homocysteine levels [gt] 7 micromol/L increase the risk for CVD in a linear dose-response relationship with no specific threshold level. Elevated s-Hcy has responded favorably to vitamin supplementation in several epilepsy studies. However, s-Hcy remains elevated despite use of vitamins in half of the subjects. Other factors such as lipids, blood pressure and obesity require more intensive intervention. Preventative care in epilepsy clinic should consist of appropriate CVD screening with culturally sensitive health promotion.