TSC Abstracts/ORALS

Anatol J Cardiol 2019; 22 (Suppl 1): 1-120 October 3-6, 2019 59

Coronary artery disease / Acute coronary syndrome Epidemiology

OP-138 OP-140

Genes related with aspirin resistance may also cause
recurrent coronary artery disease
Emrah Bayam,1 Deniz Kıraç2
Department of Cardiology, S.B. Ümraniye Training and Research Hospital, İstanbul
1 Muhlisttin Emre Erkuş,1 Ataman Gönel,2 İsmail Koyuncu,2 Halil İbrahim Altıparmak,1 Recep Demirbağ1
2
Department of Medical Biology, Yeditepe University Faculty of Medicine, İstanbul
Background and Aim: Coronary artery disease (CAD) and its complications are the major causes of death in
the world. Acetyl salicylic acid is the most commonly used antiplatelet drug for treatment of CAD. However,
significant fraction of acetyl salicylic acid -treated patients may be resistant to the antiplatelet effects of
the drug therefore recurrent CAD is detected in some patients due to acetyl salicylic acid resistance (AR).
However it is a multifactorial disease, genetic backround is also important. Therefore the aim of this study
is to investigate the effects of Cyclooxygenase (COX)-1 and COX-2 mutations, environmental factors to AR
and recurrent CAD.
Methods: A hundred CAD patients taking 100 mg acetyl salicylic acid daily during 2 years were enrolled into
the study. The patients were divided into two groups according to their recurrent CAD status. 48 patients
with recurrent CAD were selected to the patient group and 52 patients without recurrent CAD were select-
ed to the control group. The information regarding the risk factors such as smoking, alcohol consumption
etc. were also obtained. DNA was isolated from peripheral blood. The presence of rs1330344 in COX-1 and
rs20417 in COX-2 were determined by using real time polymerase chain reaction (RT-PCR). Results were
evaluated statistically.
Results: At the end of the study, COX-1 (%33.3) and COX-2 (%33.3) mutations were mostly detected in the
patient group. When allel frequencies were compared between groups, C allele of COX-2 was found statis-
tically high in patient group (p<0.05). It was also found that high total cholesterol and LDL cholesterol levels
are related with GC genotype of COX-2.
Conclusions: It was suggested that there is a relation between COX-2 mutations and recurrent CAD due
acetyl salicylic acid. Basic research is required to explain the mechanisms governing the association of
COX-1 and COX-2 genotypes and response to acetyl salicylic acid in recurrent CAD patients.
The relationship among paroxysmal atrial fibrillation,
oxidative stress and DNA damage
Mustafa Beğenç Taşcanov,1 Zulkif Tanriverdi,1 Fatih Güngoren,1 Feyzullah Beşli,1
1
Department Cardiology, Harran University Faculty of Medicine, Şanlıurfa
2
Department Biochemistry, Harran University Faculty of Medicine, Şanlıurfa
Background and Aim: Atrial fibrillation (AF) is the most common seen cardiac arrhythmia in clinical practice
with increasing age. It is associated with electrophysiological, contractile and structural remodeling. Al-
though its pathophysiology has not been exactly understood, oxidative stress (OS) and inflammation seems
as important triggers. Previous experimental studies demonstrated that increased oxidative stress (OS) was
associated with AF. However, data in human regarding the relationship between paroxysmal AF and OS is
limited. To our knowledge, there is no study investigating the association of OS with PAF. The aim of this
study was to investigate the relationship between oxidative stress parameters and DNA damage in the
development of atrial remodeling in patients with PAF.
Methods: This study was designed as a prospective case control study and included 56 patients with PAF
and 31 healthy participants. Patients with previous known heart failure, severe heart valve disease, coro-
nary artery disease, malignancy, rheumatic and hematological diseases, liver disease and renal failure; and
those who did not provide consent for participation in the study were excluded. The OS was measured with
total oxidant status (TOS), total antioxidant status (TAS) and oxidative stress index (OSI). The level of DNA
damage was measured with 8-Hydroxydeoxyguanosine (8-OHdG).
Results: There was no significant difference between the groups in terms of baseline characteristics
and echocardiographic variables (Table 1 and 2). However, serum TOS (p=0.001), OSI (p=0.001), 8-OHdOG
(p=0.019), and hs-CRP (p=0.018) were significantly higher in patients with PAF compared to control group
(Table 3). In correlation analysis, serum TOS level was positively correlated with 8-OHdOG (r=0.348, p=0.001),
OSI (r=0.822, p=0.001) and CRP (r=0.325, p=0.002), whereas negatively correlated with TAC (r=0.300, p<0.005).
Multivariate logistic regression analysis showed that serum TOS levels (odds ratio [OR], 1.723; 95% confi-
dence interval [CI], 1.091-2.722; p<0.020) was the only independent predictors of the PAF (Table 3). ROC curve
analysis was used to determine the optimal cut-off value of TOS for predicting PAF. TOS ≥12.2 predicted
PAF with a sensitivity of 82% and specificity of 76% (area under curve: 0.785, 95% CI: 0.687–0.883, p<0.001)
(Figure 1).
Conclusions: In this study, we demonstrated OS and DNA damage was significantly higher in patients with
PAF compared to control group. In addition, high TOS level was an independent predictor of PAF. Therefore
we can suggest that treatment approaches that increase the level of antioxidants (i.e. lifestyle changes,
vitamins supplement) may be given in PAF patients with higher level of TOS.

Table 1. Baseline characteristics laboratory of the study

population

Family medicine

OP-139

Investigation of combined antihypertensive drug utilization

in the primary care in Istanbul
Figure 1. ROC of TOS and PAF.
Ömer Ataç,1 Volkan Aydın,2 Ahmet Akıcı2
1
Department of Public Health, İstanbul Medipol University Faculty of Medicine, İstanbul
2
Department of Medical Pharmacology, Marmara University Faculty of Medicine, İstanbul
Background and Aim: Essential hypertension (HT) is one of the indications in which primary care plays a
Table 2. Baseline characteristics and echocardiographic of the study population
critical role in diagnosis and treatment. HT has become a disease with the increasing use of combination
therapy recommended even for the initial treatment. This study aimed to investigate the use of combined
antihypertensive drugs in HT prescriptions generated by family physicians in Istanbul was examined.
Methods: The study included prescriptions with only single essential HT diagnosis and written in the entire
year 2016 in a total of 1431 family medicine units, which were selected by systematic sampling from all 4293
family medicine units of Istanbul.
Results: In the study, the total number of prescriptions with a single diagnosis of HT was found to be 280.772.
It was detected that 58.1% of these prescriptions were written to women (n=162.904) and 19.0% (n=53.316)
to patients ≥75 years (mean age: 63.45±12.3 years). Among the total 264,326 prescriptions including at least
one antihypertensive drug; 43.4% (n=114.780) contained single, 43.6% (n=115.226) two, and 13.0% (n=34.320)
more than two antihypertensive drugs. It was found that 87.4% (n=130.712) of the prescriptions that includ-
ed ≥2 antihypertensive drug contained a fixed-dose combination. Women and <75-year-old patients were
detected to be significantly more likely to receive combined antihypertensive medication (57.8% and 57.2%,
respectively) than were male and ≥75-year-old patients (54.9% and 54.0%, respectively; p<0.001 for each).
Metoprolol was the most commonly prescribed drug (22.0%) in the monotherapy group, followed by amlodip-
ine (15.8%) and ramipril (9.0%). In prescriptions containing ≥2 antihypertensive medications, the most pre-
ferred combinations were valsartan+hydrochlorothiazide ([HCTZ] 13.2%), candesartan+HCTZ (12.9%), and
perindopril+indapamide (10.7%). HCTZ was the most commonly used active ingredient (64.4%) in fixed-dose
combinations, and the angiotensin-II-receptor blocker (ARB)+diuretic combination was the most commonly
prescribed drug group (45.9%). In all combinations, angiotensin-converting enzyme inhibitor and ARB were
used in a total of 948 (0.6%) prescriptions, while renin-angiotensin-aldosterone system drugs and potassi-
um-sparing diuretics were concomitantly prescribed in 675 (0.5%) prescriptions.
Conclusions: It is understood that family physicians prescribe multiple antihypertensive drugs in more than
half of their practices in the management of HT and they prefer fixed-dose combinations in approximately
two-thirds of them. While this approach in the primary care appears to be consistent with current treat-
ment guidelines, it is remarkable that an unneglectable number of prescriptions contained inappropriate
antihypertensive combinations. This finding indicates the need for future research probing causes of such
irrational antihypertensive drug use to develop actions for solutions.