Pantoprazole effect of treatment on inflammatory markers in pati̇ents taking pitavastati̇n for dyslipidemia

Introduction and Aim: There is evidence that statins reduce circulating pro-inflammatory cytokine levels in individuals with cardiovascular risk factors due to their anti-inflammatory effect. There are limited studies of pitavastatin, which is a new member of the statins, explaining its anti-inflammatory effect, like other statin group drugs, and we have not found clear information in the literature about the mechanism by which it acts and its effects on pro-inflammatory cytokines. Proton pump inhibitors have also been found to have anti-inflammatory effects in some studies, but relevant studies are contradictory. In our study, we aimed to evaluate the cholesterol-lowering effect of pitavastatin, which has been frequently used recently, and its effect on inflammation markers when used in combination with pantoprazole. Materials and Methods: In our study, which was conducted as a prospective, observational cohort, patients who came to the Internal Medicine Outpatient Clinic of Bezmialem Vakıf University Faculty of Medicine and were started on pitavastatin treatment for primary prevention according to the ESC guideline (LDL-C >190 mg/dl) were divided into two groups: those using pantoprazole and those not using pantoprazole. Among the patients followed for 3 months, those using pitavastatin constituted the first group (Group 1), and those using pitavastatin and pantoprazole together constituted the second group (Group 2). In two groups of patients (LDL-C, HDL-C, Triglyceride, Urea, Creatinine, Glucose, AST, ALT, GGT, ALP, LDH, CRP) were tested before and after treatment , and inflammation markers (IL-1β, IL-6 ,TNF-α) blood was taken and stored at -80 °C. After the study was completed, all patients were tested and their results were compared. Results: When the initial frequencies were examined according to the groups, no significant difference was detected in the demographic characteristics and initial laboratory values in both groups. When the values of Group 1 and Group 2 were compared between the time when treatment was started and 3 months after treatment, a significant decrease in LDL cholesterol and Triglyceride levels was found in Group 1 (P<0.001, P: 0.02, respectively). Similarly, a significant decrease in LDL cholesterol and triglyceride was detected in group 2 (p<0.010, P:0.001, respectively). Unlike group 1, a significant increase in IL-6 was detected in group 2 (P<0.001). At the end of 3-month follow-up, an increase in IL-1 β and TNF-α levels was detected in both groups, although it was not statistically significant. A significant increase in IL-6 level was detected only in group 2. Conclusion: In our study, we observed that when pitavastatin and pantoprazole were used together, the level of IL-6, one of the pro-inflammatory markers, increased significantly at the end of the 3rd month. We found that although pitavastatin significantly reduced LDL cholesterol and triglyceride, it did not reduce pro-inflammatory cytokine levels, and when pantoprazole was added to the treatment, the inflammatory effect increased. We think that prospective, large-scale studies are needed to reach more definitive results. Keywords: Dyslipidemia; İnflammatory biomarkers (IL-1 β, IL-6, TNF- α); Pitavastatin; Pantoprazole