TY - JOUR
T1 - Valproate attenuates the risk of myocardial infarction in patients with epilepsy: a nationwide cohort study
AU - Olesen, Jonas Bjerring
AU - Hansen, Peter Riis
AU - Abildstrøm, Steen Zabell
AU - Andersson, Charlotte
AU - Weeke, Peter
AU - Schmiegelow, Michelle
AU - Erdal, Jesper
AU - Torp-Pedersen, Christian
AU - Gislason, Gunnar Hilmar
AU - Hansen, Peter Riis
AU - Abildstrøm, Steen Zabell
N1 - Copyright © 2010 John Wiley & Sons, Ltd.
PY - 2011/2/1
Y1 - 2011/2/1
N2 - Purpose: Patients with epilepsy have increased risk of myocardial infarction (MI). Valproate can exert anti-atherosclerotic effects. We therefore examined the risk of MI in patients with epilepsy receiving valproate. Methods: Two cohorts of patients with valproate-treated epilepsy and sex- and age-matched individuals (controls) from the general Danish population were identified by individual-level-linkage of nationwide registries and followed for 10 years. The two cohorts comprised patients treated with valproate at baseline and valproate-naïve patients initiating treatment in the study period, respectively. The hazard ratios (HR) of MI and all-cause death were estimated by two different Cox proportional-hazard models; valproate treatment was analysed as a baseline categorical covariate in the first cohort and as a time-dependent exposure covariate in the second cohort. Results: The two cohorts comprised 53086 and 102003 individuals, respectively. In the first cohort, the risk of MI was decreased (HR 0.75, 95% confidence interval 0.59-0.97) while the risk of all-cause death was increased (HR 2.11, 95% confidence interval 1.95-2.28), compared to the controls. In the second cohort, the risk of MI was decreased (HR 0.62, 95% confidence interval 0.53-0.73) while the risk of all-cause death was similar to the controls (HR 1.02, 95% confidence interval 0.97-1.07). Conclusions: In this nationwide pharmacoepidemiological study, we found a consistent association between valproate treatment and a reduced risk of MI in patients with epilepsy.
AB - Purpose: Patients with epilepsy have increased risk of myocardial infarction (MI). Valproate can exert anti-atherosclerotic effects. We therefore examined the risk of MI in patients with epilepsy receiving valproate. Methods: Two cohorts of patients with valproate-treated epilepsy and sex- and age-matched individuals (controls) from the general Danish population were identified by individual-level-linkage of nationwide registries and followed for 10 years. The two cohorts comprised patients treated with valproate at baseline and valproate-naïve patients initiating treatment in the study period, respectively. The hazard ratios (HR) of MI and all-cause death were estimated by two different Cox proportional-hazard models; valproate treatment was analysed as a baseline categorical covariate in the first cohort and as a time-dependent exposure covariate in the second cohort. Results: The two cohorts comprised 53086 and 102003 individuals, respectively. In the first cohort, the risk of MI was decreased (HR 0.75, 95% confidence interval 0.59-0.97) while the risk of all-cause death was increased (HR 2.11, 95% confidence interval 1.95-2.28), compared to the controls. In the second cohort, the risk of MI was decreased (HR 0.62, 95% confidence interval 0.53-0.73) while the risk of all-cause death was similar to the controls (HR 1.02, 95% confidence interval 0.97-1.07). Conclusions: In this nationwide pharmacoepidemiological study, we found a consistent association between valproate treatment and a reduced risk of MI in patients with epilepsy.
U2 - 10.1002/pds.2073
DO - 10.1002/pds.2073
M3 - Journal article
SN - 1053-8569
VL - 20
SP - 146
EP - 153
JO - Pharmacoepidemiology and Drug Safety
JF - Pharmacoepidemiology and Drug Safety
IS - 2
ER -