The effect of simultaneous proton pump inhibitors on inflammatory markers in patients with acute coronary syndrome who using dual antiplatelet therapy

Aim. In this study, we aimed to evaluate the short term effect of simultaneous proton pump inhibitors on inflammatory markers in patients with acute coronary syndrome who using dual antiplatelet therapy. Method. The patients who were diagnosed with acute coronary syndrome who were admitted to the outpatient clinic of Zonguldak Bülent Ecevit University, Faculty of Medicine, Health Application and Research Center, Cardiology Department between March 1, 2018 and May 31, 2018 and who were treated with oral dual antiplatelet and proton pump inhibitor for the first time were included in the study. The sample size was determined using the G Power 3.1 statistical program and 90 patients were included in the study. The patients were divided into three groups according to their PPI preparations; as Lansoprazole (n=30), Rabeprazole (n=31) and Pantoprazole (n=29). Biochemical parameters, ADMA and copeptin levels were examined at the time of admission, at the end of 1st and 6th months, and analyzed with SPSS 21. (IBM). Primer endpoint was determined as development of additional cardiovascular events in patients, change of ADMA and copeptin levels in patients with and without developing cardiovascular events; secondary endpoint was determined as the change in biochemical markers of patients with acute coronary syndrome according to PPI preparation. Results. Of the 90 patients included in the study, 70 patients were male (77.8%), 20 patients were female (22.2%). The mean age was 58.3 and the mean BMI was 28.1. The majority of the patients were overweight or obese (80%). The three most common diseases were hypertension (50%), diabetes mellitus (24.4%) and hyperlipidemia (22.2%) among the participants. 57 of the 90 patients (63.3%) had a smoking history. The biochemical values, ADMA and copeptin levels were evaluated at the time of admission, first month and sixth month of the combined PPI and dual antiplatelet therapy. At the end of sixth month, total cholesterol, LDL, troponin and CK-MB levels significantly decreased according to the time of admission (p<0.05). In addition, glucose levels decreased in the rabeprazole group, glucose and NLR levels decreased in lansoprazole group and NLR levels decreased in pantoprazole group, significantly (p<0.05). At the first month evaluation, only lansoprazole significantly increased the serum ADMA levels (p=0.04) and only pantoprazole significantly decreased the serum copeptin levels according to the time of admission (p<0.01). At the end of the sixth month, the serum ADMA levels significantly increased according to the time of admission and first-month evaluation in all 3 groups (p<0.01). At the end of the sixth month, lansoprazole and pantoprazole significantly increased the serum copeptin levels (p<0.001 and p=0.001, respectively) compared to the time of admission and first month evaluation. At the end of the sixth month, rabeprazole significantly increased the serum copeptin levels compared to the first month evaluation (p=0.02) but there was no statically significant change compared to the time of admission. Patients were evaluated in terms of newly developed cardiovascular problems after 6 months of combined therapy with PPI and dual antiplatelet. 8 of 90 patients had additional cardiovascular problems. 3 patients in the rabeprazole group (1 for ACS, 1 for stent thrombosis, 1 for mortality), 4 patients in the pantoprazole group (1 for mortality, 3 for ACS) and 1 patient in the lansoprazole group (stent thrombosis) developed additional cardiovascular problems. According to our study, the most common additional cardiovascular problems were seen in the pantoprazole group. However, the number of patients was insufficient and no statistical analysis could be performed. Conclusion. In our study, it was determined that the use of PPI causes changes in ADMA and copeptin levels in inflammatory markers. Although there are different results in the literature, various changes in blood values have been reported with the use of PPI. In the light of the findings of this study, changes in blood values should be examined in more detail as specific to preparate. Extensive studies will be useful in the effects of different inflammatory effects of initiation of PPI preparations with dual antiplatelet in patients with ACS. Keywords. ADMA, Copeptin, Acute Coronary Syndrome, Proton Pump Inhibitor, Inflammatory Markers