Medizinische Universität Graz - Research portal
Selected Publication:
Gößler, J.
Influence of P2Y12 Inhibitors and Statins on Cardiovascular Risk Factors in Patients after PCI
Humanmedizin; [ Diplomarbeit ] Graz Medical University; 2017. pp.
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- Authors Med Uni Graz:
- Advisor:
- Zweiker Robert
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- Abstract:
- Background Cardiovascular disease is nowadays still the leading cause of death in Austria. An acute coronary syndrome can be treated within a few hours by revascularisation through a percutaneous coronary intervention (PCI), but the exclusive application of stents is not sufficient as the final treatment. The secondary prevention is becoming more and more a major part of modern medicine. Despite the traditional risk factors including smoking, elevated lipids, physical inactivity, obesity, nutrition, diabetes mellitus and hypertension, there is evidence of a new arising risk factor, the elevated uric acid. Ticagrelor is a drug frequently used after PCI for the prevention of a stent thrombosis and it has already been associated with elevated uric acid levels in previous studies. This thesis is going to analyse to which extent ticagrelor influences on uric acid compared to other antithrombotic drugs. The second focus of this thesis is on the other cardiovascular risk factors and especially if there is a connection between statin therapy and markers for diabetes. Material and methods The patient population of this diploma thesis is consisting of the former participants of the Global Leaders trial in Graz (1). In this all-comer study, the antithrombotic therapy after PCI is investigated. The ticagrelor monotherapy for two years, with only one month of acetylsalicylacid at the beginning, is compared to standard therapy with ticagrelor or clopidogrel for one year and acetylsalicylacid as lifelong therapy. In this thesis, the after two years remaining medical groups ticagrelor and acetylsalicylacid were compared. Therefore, baseline laboratory values and 24-months follow-up values were collected out of the medical recording system. Additionally, a questionnaire was handed out at the end-visit in order to evaluate the lifestyle changes. An ethical approval was obtained (EK-number: 28-228 ex 15/16). vi Results No significant difference in uric acid levels between baseline and 24 months could be observed in ticagrelor and acetylsalicylacid group. (p=1.04 for ticagrelor and p=0.432 for acetylsalicylacid). Having a closer look at the means and medians, the values in ticagrelor group were higher (rise in mean between baseline and 24 months: 0.33mg/dl for ticagrelor and 0.04mg/dl for acetylsalicylacid. Elevation in medians: 0.45mg/dl in ticagrelor group and no difference in acetylsalicylacid). This insignificant elevation could not be referred to the kidney function. Further no significant changes in the markers for diabetes mellitus HbA1c (p=0.712) and fasting glucose (p=0.294) in patients with a two-year statin therapy could be observed, in patients with diabetes mellitus, as well as in those without. Concerning secondary prevention, a significant reduction of LDL cholesterol and a significant rise in HDL cholesterol after two years could be pointed out. The remarkable issue was a significant lower LDL cholesterol in ticagrelor group compared with acetylsalicylacid. (p=0.020). Although LDL cholesterol and HDL cholesterol improved, only 45% of the patients reached their targets for LDL cholesterol. The lifestyle analysis showed amongst others, 56.5% of the patients who smoked at time of their PCI quitted smoking and 46.5% are persistent smokers. Conclusio The real impact of uric acid on cardiovascular risk has to be investigated in the future via randomized trials with uric acid lowering therapy. Ticagrelor seems to elevate uric acid, even though it is not significant. Concerning markers for diabetes mellitus and statins, there was no influence in the analysis, thus, the positive effects of lowering lipids are superior to the potential prodiabetogenic effects. There were worrying results about lifestyle parameters and reaching their targets in secondary prevention. This should give an impact to improve patient’s education and to implicate more rehabilitation programs in the future.