Evaluation of the frequency of acetyl salicylic acid resistance in the patients with ischaemic heart disease and coexistent chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease is a leading cause of mortality and morbidity with 3 million deaths worldwide. It is estimated that mortality caused by COPD will rise 15% in the upcoming 15 years. COPD is also an important risk factor for ischaemic heart disease and it is observed that 20-50% of mortality in this disease is caused by cardiovascular events. In the recent years a lot of studies has shown that COPD is an independent risk factor for cardiovascular diseases even after excluding the effects of cigarette smoking, older age and sex. This coexistence is based on the common inflammatort pathways the two diseases share, such as IL-6, IL-1β, IL-8, TNF-α, which are elevated in this disease. Chronic inflammation plays a role in both conditions and the effects of statins in cardiovascular diseases and steroids in COPD are both popular investigation subjects in this aspect. In addition to these, hypercoagulability, platelet activation, hypoxia and elevated oxidative stress exist in this COPD. Acetyl salicylate resistance is defined as lack of antiplatelet effect despite the use of standart dose acetyl salicylate (75-300 mg/day). Possible mechanisms under this condition are inadequate bioavailability, competition for attachment to the COX-1 channel with agents such as indomethacin, ibuprofen, platelet activation with mechanisms independent of acetyl salicylate (ADP, shear stress) and the shift of thromboxane production from COX-1 to COX-2 isoenzyme. It is known that in inflammatory conditions resistance to acetyl salicylate is increased. There is no definite way to measure acetyl salicylate resistance but systems that are based on Born method are used to assess platelet aggregation (PFA-100®, VerifyNow®, MultiPlate®). Another method to measure aggregation is looking for thromboxane metabolites( 11-β dehidrotromboksan B2) in urine (AspirinWorks®). Ongoing inflammation in COPD is thought to be associated with increased acetyl salicylate resistance which causes cardiovascular events. Purpose The aim of this study is to evaluate the frequency of acetyl salicylate resistance in patients with ischaemic heart disease and COPD. Method 200 patients with ischaemic heart disease, in which COPD is coexistent in 100 patients, were taken in the study. Patients were enrolled from the cardiology and pulmonary medicine polyclinics in Şişli Florence Nightingale Hospital of İstanbul Bilim University. Diagnosis of COPD was made with a FEV1 level less than 70% and FEV1/FVC level less than 80% in pulmonary function test. Patient enrollment was made with simple random recruitment. After that patients were taken into a questionaire for demographic variables (cardiac risk factors,family history, drug usage), blood samples were taken for acetyl salicylate resistance and leucocyte levels. Multiplate® method was used for the assessment of resistance. The level of association was defined with SPSS v.13 statistics programme. Exclusion criteria were rheumatologic, inflammatory conditions other than COPD and IHD, active infection, thrombocytopenia, essential thrombocytosis, hereditary platelet function abnormalities, use of indomethacin, ibuprofen, metamizole. Result: The coexistence of COPD in IHD patients does not lead to a significant increase in acetyl salicylate resistance (p>0,05).