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

Abstract

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.

Keywords

• Nitrat,baş ağrısı,ateroskleroz

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

Abstract

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 significantly 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 significantly 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.

Keywords

• Nitrates,headache,atherosclerosis

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