comparison of myocardial perfusion between the users of two antiepileptic medications: valproate vs. carbamazepine

Objective(s): the prevalence of coronary artery disease (cad) is high in patients with epilepsy using antiepileptic drugs (aed). epilepsy, aed, or the type and duration of aed use , may contribute to higher cad risk.in this study, myocardial perfusion imaging (mpi) was compared between patients using carbamazepine and valproate.method: out of 73 patients receiving carbamazepine or valproate monotherapy for more than 2 years, visited at a tertiary referral clinic, 32 patients participated in a 2-day stress and rest phases mpi. for each phase, 15-25 mci 99mtc-mibi was injected, at peak exercise or by pharmacologic stimulation for the stress phase. spect with cardiac gating was done by a dual-head gamma camera and processed and quantified. scans with at least one definite reversible hypo-perfusion segment were considered abnormal.results: seventeen patients received carbamazepine monotherapy and 15 valproates. age and duration of aed use were similar between the groups. two scans were abnormal (6.3%) both in valproate group (13.3%). duration of aed use was higher in patients with abnormal scans. in patients receiving monotherapy >2 years, the frequency of abnormal mpi was similar between groups (p-value=0.12).  in patients receiving monotherapy > 5 years, prevalence of abnormal mpi was higher in the valproate group (28.6% vs. 0.0%; p-value=0.042). considering valproate subgroup, ischemic patients had higher duration of aed use, comparing with the normal patients (17.0±4.2 vs. 6.4±4.8, p-value=0.014). conclusion: mpis were abnormal in patients receiving valproate after 5 years compared to patients receiving carbamazepine. long-term valproate use may increase the risk of cad.