Hakan ERKAN, Gülhanım KIRIŞ, İsmail Gökhan ÇAVUŞOĞLU, Şükrü ÇELİK, Levent KORKMAZ

Predictive Value of Nitrate-Induced Headache on Atherosclerotic Burden in Patients with Stable Coronary Artery Disease

Giriş: Damarlarda genişlemeye yol açan nitratlar antianginal tedavinin köşetaşı ilaçlarından biridir. Nitratların en sık karşılaşılan yan etkisi beyin arterlerinin genişlemesi ile bağlantılı oluşan baş ağrısıdır. Nitratlara karşı damar genişletici cevap aterosklerozlu hastalarda anlamlı olarak azalmıştır. Bu çalışmanın amacı kararlı koroner arter hastalığı olan hastalarda nitratların indüklediği baş ağrısı (NİB) ile sistemik ve koroner aterosklerotik yük arasındaki ilişkiyi belirlemektir.Hastalar ve Yöntem: NİB olan kırk hasta (grup I: 61.2 ± 8.56 yıl, 32 erkek) ve NİB olmayan atmış iki hasta (63.5 ± 8.45 yıl, 41 erkek) çalışmaya kaydedildi. Sistemik aterosklerotik yük karotis intima-media kalınlığı (KİMK) ve kalp-ayak bileği damar indeksi (KADİ) ile değerlendirildi. Koroner aterosklerotik yük, Gensini skoru ile değerlendirildi.Bulgular: KİMK ve KADİ grup ll'de grup I'e göre anlamlı olarak daha büyüktü. (0.8 ± 0.20 karşı 0.6 ± 0.20 ve 9.5 ± 1.00 karşı 8.4 ± 1.20 p< 0.001, sırasıyla). Gensini skoruda grup ll'de grup l'den daha yüksekti. [ortanca 32 (16.7-45.2) karşı 12.5 (5.2-19.2) p< 0.001]. Multivariate analizde baş ağrısı KİMK, KADİ ve Gensini skorunun bağımsız belirleyicisi olarak bulundu (p< 0.001 ).Sonuç: NİB olan hastalar NİB olmayanlarla karşılaştırıldığında KİMK, KADİ ve Gensini skoru ile belirlenmiş düşük seviyede sistemik ve koroner ateroskleroz yüke sahiptir.

Kararlı Koroner Arter Hastalığı Olan Hastalarda Nitratların Oluşturduğu Baş Ağrısının Aterosklerotik Yükü Öngörmedeki Değeri

Introduction: Nitrates, which lead to vasodilation in vessels, is one of the cornerstone drugs of antianginal therapy. The most frequently encountered side effect of nitrates is headache, which is linked to vasodilation of the cerebral arteries. Vasodilator response to nitrates is signifi cantly reduced in patients with atherosclerosis. The aim of present study was to assess the relationship between nitrate-induced headache (NIH) and systemic and coronary atherosclerotic burden in patients with stable coronary artery disease. Patients and Methods: Overall, 40 patients with NIH (group I: 61.2 ± 8.56 years, 32 males) and 62 patients without headache (group II: 63.5 ± 8.45 years, 41 males) were included in the study. Systemic atherosclerotic burden was evaluated by carotid intima-media thickness (CIMT) and cardio-ankle vascular index (CAVI). Coronary atherosclerotic burden was assessed by the Gensini score. Results: CIMT and CAVI were signifi cantly greater in group II than in group I (0.8 ± 0.20 vs. 0.6 ± 0.20 and 9.5 ± 1.0 vs. 8.4 ± 1.2, respectively; p< 0.001). The Gensini score was also higher in group II than in group I [median 32 (16.7-45.2) vs 12.5 (5.2-19.2); p< 0.001]. In multivariate analysis, headache was found as an independent determinant of CIMT, CAVI, and Gensini score (p< 0.001). Conclusion: Patients with NIH had a low level systemic and coronary atherosclerotic burden, evaluated by CIMT, CAVI, and Gensini score, compared with those without NIH.

PDF

___

Shirai K, Hiruta N, Song M, Kurosu T, Suzuki J, Tomaru T, et al. Cardio- ankle vascular index (CAVI) as a novel indicator of arterial stiffness: theory, evidence and perspectives. J Atheroscler Thromb 2011;18:924-38.
van den Oord SC, Sijbrands EJ, ten Kate GL, van Klaveren D, van Domburg RT, van der Steen AF, et al. Carotid intima-media thickness for cardiovascular risk assessment: systematic review and meta-analysis. Atherosclerosis 2013;228:1-11.
Gensini GG. A more meaningful scoring system for determining the severity of coronary heart disease. Am J Cardiol 1983;51:606.
Abrams J. Mechanism of action of the organic nitrates in the treatment of myocardial ischaemia. Am J Cardiol 1992;70:30-40.
Raitakari OT, Seale JP, Celermajer DS. Impaired vascular responses to nitroglycerin in subjects with coronary atherosclerosis. Am J Cardiol 2001;15;87:217-9.
Akerman S,Williamson DJ, Kaube H, Goadsby PJ. Nitric oxide synthase inhibitors can antagonize neurogenic and calcitonin generelated peptide induced dilation of dural meningeal vessels. Br J Pharmacol 2002;137:62-8.
Sivri N, Tekin G, Erbay AR, Yalta K, Senen K, Gür M, et al. Headache response to nitrate in patients with coronary artery disease and systolic heart failure. Int J Cardiol 2012 26;158:453-4.
Fye WB, Lauder T. Brunton and amyl nitrite: a Victorian vasodilator. Circulation 1986;74:222-9.
Battock DJ, Levitt PW, Steele PP. Effects of isosorbide dinitrate and nitroglycerin on central circulatory dynamics in coronary artery disease. Am Heart J 1976;92:455-8.
Fremont RE. The actions of organic nitrates on the cardiopulmonary and peripheral circulations. Angiology 1961;12:391-400.
Bassan MM, Weiler-Ravell D. The additive antianginal action of oral isosorbide dinitrate in patients receiving propranolol. Magnitude and duration of effect. Chest 1983;83:233-40.
Chrysant SG, Glasser SP, Bittar N, Shahidi FE, Danisa K, Ibrahim R, et al. Effi cacy and safety of extended-release isosorbide mononitrate for stable effort angina pectoris. Am J Cardiol 1993;72:1249-56.
Hansen JM, Pedersen D, Larsen VA, Sánchez-del-Rio M, Alvarez Linera JR, Olesen J, et al. Magnetic resonance angiography shows dilatation of the middle cerebral artery after infusion of glyceryl trinitrate in healthy volunteers. Cephalalgia 2007;27:118-27.
Dahl A, Russell D, Nyberg-Hansen R, Rootwelt KDahl A, Russell D, Nyberg-Hansen R, et al. Effect of nitroglycerin on cerebral circulation measured by transcranial Doppler and SPECT. Stroke1989; 20:1733-6.
Bednarczyk EM, Wack DS, Kassab MY, Burch K, Trinidad K, Haka MBednarczyk EM, et al. Brain blood fl ow in the nitroglycerin (GTN) model of migraine: measurement using positron emission tomography and transcranial Doppler. Cephalalgia 2002;22:749-57.
Adams MR, Robinson J, McCredie R, Seale JP, Sorensen KE, Deanfi eld JE, et al. Smooth muscle dysfunction occurs independently of impaired endothelium-dependent dilation in adults at risk of atherosclerosis. J Am Coll Cardiol 1998;32:123-7.
Lai CP, Koyanagi S, Shaw CK, Takeshita A. Evaluation of the early stage of carotid atherosclerosis using the vascular response to nitroglycerin and high-resolution ultrasonography. Jpn Circ J 1998;62:494-8.
Hsi DH, Roshandel A, Singh N, Szombathy T, Meszaros ZS. Headache response to glyceryl trinitrate in patients with and without obstructive coronary artery disease. Heart 2005;91:1164-6.
Cho SH, Jeong MH, Sim DS, Hong YJ, Park HW, Kim JH, et al. Diagnostic value of nitroglycerin-induced headache as negative predictor of coronary atherosclerosis. Chonnam Med J 2011;47:14-9.

ISSN: 2149-2972
Yayın Aralığı: Yılda 3 Sayı
Başlangıç: 1990
Yayıncı: Sağlık Bilimleri Üniversitesi, Kartal Koşuyolu Yüksek İhtisas Eğitim ve Araştırma Hastanesi