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Long-term therapy with antiseizure medications (ASMs) has been associated with metabolic consequences that lead to an increase in the risk of atherosclerosis in patients with epilepsy. This study was conducted to assess the effects of ASMs on vascular risk factors namely, serum Lipid profile and C-reactive protein (CRP) in epileptic patients and to assess the correlation between the duration of the ASMs, and carotid intima media thickness (IMT). Forty three adult patient participants who were receiving ASM monotherapy for more than 2 years and 43 control patients were enrolled in this study. All participants received measurement of common carotid artery (CCA) and IMT by B-mode ultrasonography to assess the extent of atherosclerosis. Other measurements included body mass index (BMI), serum lipid profile and CRP. The correlation between duration of ASM and average carotid IMT was calculated by using the Pearson's correlation coefficient method. The majority of subjects on phenytoin 8 (66.7%) were positive for CRP. There was an equal proportion of patients on carbamazepine who were equally positive 5(50%) and negative 5(50%) for CRP. There was a statistically significant association between phenytoin consumption and CRP positivity. There was positive correlation between duration of phenytoin consumption and average IMT. There was a strong positive correlation between duration of phenobarbitone consumption and average IMT and was statistically significant. Our results also suggest that long-term use of ASMs with prominent effects on the enzyme system, including Carbamazepine, phenytoin, sodium valproate or phenobarbitone may contribute to the progression of atherosclerosis in patients with epilepsy.

Cardiac involvement in systemic sclerosis (SSc) can manifest in a variety of ways, from pericardial disease, conduction abnormalities, myocardial ischemia, to overt heart failure (HF). HF in SSc patients is due to an interplay of microvascular disease and myocardial inflammation, resulting in fibrosis and myocardial dysfunction. Large scale data analyzing the relationship between systemic sclerosis and heart failure is lacking. We aimed to analyze the in-hospital outcomes and characteristics of patients admitted with heart failure with co-morbid SSc, and compare them to those without SSc, using the National Inpatient Sample (NIS) from 2016 to 2019. Given the significant difference in the pathophysiology of SSc-associated HF, we hypothesized that these patients would have different baseline clinical characteristics, as well as worse cardiovascular outcomes, compared to patients without SSc. Data from 2016 to 2019 were extracted from the NIS database. A search was performed using International Classification of Diseases, Tenth Revision codes (ICD-10) for heart failure and systemic sclerosis. Patients hospitalized with a primary diagnosis of heart failure along with secondary diagnoses of systemic sclerosis were identified. Baseline demographics and characteristics were analyzed. Multivariate logistic and linear regression analysis was used to adjust for confounders. Outcomes of mortality, length of stay (LOS), and costs were compared between the two groups. We identified 4,820,214 hospitalizations with a primary diagnosis of heart failure. 8,180 (0.17 %) were noted to have SSc. 82.3% of patients with HF and comorbid SSc were female (vs 47.8% in HF without SSc). These patients were also noted to have lower rates of coronary artery disease (35.9% vs 50.6%), hyperlipidemia (39.4% vs 52.8%), diabetes (23.2% vs 49.0%), and obesity (13.3% vs 25.0%). They had higher rates of concurrent interstitial lung disease (12.1% vs 0.8%), pulmonary hypertension (35% vs 12.6%) and oxygen dependence (22.2% vs 10.8%). Multivariate logistic regression analysis of the two groups (HF with and without SSc) showed statistically significant higher odds of in-hospital mortality in the HF and SSc group (OR 1.92, p<0.001, CI: 1.52-2.43). No clinically significant difference in LOS was noted between the two groups (HF and SSc: 6.43 vs 5.43). Mean hospitalization charges were higher in the SSc group (HF and SSc: $63,012 vs $54,639). In patients hospitalized for HF, those with SSc have 92% higher odds of in-hospital mortality than those without SSc. Patients with HF and SSc are also more likely to be younger, female, and have comorbid interstitial lung disease, pulmonary hypertension and be oxygen dependent at baseline. Additionally, these patients are less likely to have traditional cardiovascular risk factors associated with HF such as CAD, hyperlipidemia, diabetes, and obesity. [ABSTRACT FROM AUTHOR]