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PP-103 UNUSUAL LIPID LOWERING DRUGS-ASSOCIATED NEUROPSYCHIATRIC ADVERSE EVENTS
Posters / International Journal of Cardiology 155S1 (2012) S129–S227
PP-103 UNUSUAL LIPID LOWERING DRUGS-ASSOCIATED NEUROPSYCHIATRIC ADVERSE EVENTS M.C. Sumerkan1 , E. Kaya2 , S. Bulur3 , S.B. Sozen1 , G. Guler1 , E. Guler1 , A. Surgit4 , M.A. Agirbasli5 , S. Oksuz6 . 1 Cardiology Clinic, Duzce Ataturk State Hospital, Duzce, Turkey; 2 Department of Pharmacology, Duzce University Faculty of Medicine, Duzce, Turkey; 3 Department of Cardiology, Duzce University Faculty of Medicine, Duzce, Turkey; 4 Psychiatry Clinic, Duzce Ataturk State Hospital, Duzce, Turkey; 5 Department of Cardiology, Marmara University Faculty of Medicine, Istanbul, Turkey; 6 Chief of the Hospital, Duzce Ataturk State Hospital, Duzce, Turkey Objective: Hypolipidaemic drugs are an important role on the protection from cardiovascular diseases and currently the most widely used drugs, which have been evaluated in many researches involving thousands of patients. From a safety perspective, clinical researches and post-marketing surveillance have demonstrated that they are extremely safe, generally well tolerated agents and rarely encountered in primary medical facilities with side effects, however they may cause various adverse events, these concerns about different systems and tissues of body. Lipid lowering drugs associated neuropsychiatric adverse events are very rare. Here we present a case in which the patient had neuropsychiatric adverse events for almost all kinds of lipid lowering agents (rozuvastatin, atorvastatin, pravastatin, fenofibrate, ezetimibe). Results: A 33-year-old male was admitted to cardiology policlinic with hyperlipidemia disease. He had 235 mg/dl low density lipoprotein levels. Despite of life-style change, LDL-C was decreased to non adequate level of 195 mg/dl. Hypolipidaemic drugs were given by respectively as rozuvastatin, atorvastatin, fenofibrate, pravastatin and ezetimibe. One drug not started until the other drug’s side effects disappear. He had different neuropsychiatric adverse events for different lipid lowering agents. Neuropsychiatric difficulties clear on dechallenge and reappear on rechallenge with almost all kinds of lipid-lowering drugs. Rozuvastatin caused severe headache, visual hallucinations and depression symptoms, atovastatin caused headache and sleep disorders, fenofibrate causeed memory loss and impulse control disorder, pravastatin and ezetimibe caused nightmares. His psychiatric events cleared on after discontinuation lipid lowering drugs. We confirmed the diagnosis of neuropsychiatric adverse events and exclude neuropsychiatric disorders by neurologic and psychiatric examination and cranial imaging methods. Conclusions: Patients with lipid lowering drugs associated adverse events often apply to services with myopathy and hepatotoxicity signs and symptoms; therefore clinicians bypass other rare side events, as in our case. Also very rare side effects cause patients to be misled and receive the wrong approaching techniques and treatments. Despite the importance of neuropsychiatric adverse events of lipid lowering drugs, the exact causes have not yet been established. PP-104 PREGNANCY FOLLOWED BY DELIVERY MAY AFFECT CIRCULATING SOLUBLE LECTIN-LIKE OXIDIZED LOW-DENSITY LIPOPROTEIN RECEPTOR-1 LEVELS IN WOMEN OF REPRODUCTIVE AGE M. Balin, A. Celik, ¸ M.A. Kobat. Elazig Education and Research Hospital, Elazig, Turkey Objective: The incidence of coronary artery disease (CAD) and mortality is very low in women of reproductive age. It is known that menopause or lack of endogenous estrogen is a risk factor for endothelial dysfunction and CAD. Lectin-Like Oxidized LowDensity Lipoprotein Receptor-1 (LOX-1) is involved in multiple phases of vascular dysfunction, including endothelial dysfunction, atherosclerotic plaque formation and destabilization. The purpose of the current study was to determine the association between soluble LOX-1 (sLOX-1) and pregnancy followed by delivery in women of reproductive age.
S133
Methods: Sixty-eight subjects with pregnancy followed by delivery (Group 1) and 57 subjects with non-gravidity (Group 2) were included in this study. Levels of sLOX-1 were measured in serum by ELISA. Results: Plasma levels of sLOX-1 were significantly higher in Group 1 than Group 2 in women of reproductive age (0.78±0.13 ng/mL and 0.52±0.18 ng/mL, respectively, p < 0.001). There were highly correlation between sLOX-1 levels and number of gravid (r = −0.645, p < 0.001). The levels of sLOX-1 highly correlated with number of parous (r = −0.683, p < 0.001). Conclusions: Our study demonstrated that serum sLOX-1 levels were associated with pregnancy followed by delivery that might predict endothelial dysfunction. Pregnancy followed by delivery may improve endothelial function and prevent the progress of atherosclerosis in women of reproductive age. We conclude that pregnancy followed by delivery may delay the beginning and progress of arteriosclerosis and its clinical manifestations in women of reproductive age. PP-105 A RARE CAUSE OF ISCHEMIC DILATED CARDIOMYOPATHY IN CHILDHOOD: FAMILIAL HYPERCHOLESTEROLEMIA M. Keskin, U.A. Orun, O. Ceylan, S. Ozgur, V. Dogan, S. Karademır. Dr. Sami Ulus Children’s Health and Diseases Training and Research Hospital, Ankara, Turkey Results: Dilated cardiomyopathy in childhood is often idiopathic, and it has high morbidity and mortality rates. On the contrary, ischemic dilated cardiomyopathy as a result of premature atherosclerosis and coronary artery disease caused by familial hyprecholesterolemia is quite rare in childhood. It usually manifests itself in the second decade of life. We present a male patient aged 11 years and 9 months who was admitted to our clinic with the complaints of palpitation, easy tiredness and weakness. He had been followed up with the diagnosis of familial hypercholesterolemia type 2a for two years, and had used ezetimibe and atorvastatin irregularly besides plasmapheresis sessions performed with irregular intervals. His mother had also been followed up with the diagnosis of heterozygous hypercholesterolemia. Physical examination revealed xanthomas in the legs and on the extensor surfaces of the arms. In the echocardiography, hyperechogeneity in the aortic valve and in the region where the coronary arteries exit due to calcification causing narrowing of the outlet of the coronary arteries, dilated left ventricles and excessively disturbed left ventricular functions were noted. End-diastolic diameter of the left ventricle, ejection fraction and shortening fraction were 52 mm, 35% and 16%, respectively. Serum total cholesterol, LDL cholesterol and triglyceride levels were 570 mg/dl, 513 mg/dl and 125 mg/dl, respectively. In angiography, 50% narrowing of the bifurcation of the left coronary artery and irregularity in the wall of ascending aorta were seen. In the light of these findings, it was thought that dilated cardiomyopathy developed secondary to ischemic damage. Ezetimibe and atorvastatin were initiated again, and low-fat diet, enalapril and furosemide against heart failure were recommended. Total cholesterol and LDL cholesterol levels started to decrease with regular antilipid treatment, so plasmapheresis was not indicated. The importance of the treatment was explained to the parents. Conclusions: We want to emphasize that dilated cardiomyopathy may develop as a result of ischemia in children with hypercholesterolemia early in their life, and that these cases should be followed up closely keeping in mind the possible development of cardiac complications.
PP-103 UNUSUAL LIPID LOWERING DRUGS-ASSOCIATED NEUROPSYCHIATRIC ADVERSE EVENTS M.C. Sumerkan1 , E. Kaya2 , S. Bulur3 , S.B. Sozen1 , G. Guler1 , E. Guler1 , A. Surgit4 , M.A. Agirbasli5 , S. Oksuz6 . 1 Cardiology Clinic, Duzce Ataturk State Hospital, Duzce, Turkey; 2 Department of Pharmacology, Duzce University Faculty of Medicine, Duzce, Turkey; 3 Department of Cardiology, Duzce University Faculty of Medicine, Duzce, Turkey; 4 Psychiatry Clinic, Duzce Ataturk State Hospital, Duzce, Turkey; 5 Department of Cardiology, Marmara University Faculty of Medicine, Istanbul, Turkey; 6 Chief of the Hospital, Duzce Ataturk State Hospital, Duzce, Turkey Objective: Hypolipidaemic drugs are an important role on the protection from cardiovascular diseases and currently the most widely used drugs, which have been evaluated in many researches involving thousands of patients. From a safety perspective, clinical researches and post-marketing surveillance have demonstrated that they are extremely safe, generally well tolerated agents and rarely encountered in primary medical facilities with side effects, however they may cause various adverse events, these concerns about different systems and tissues of body. Lipid lowering drugs associated neuropsychiatric adverse events are very rare. Here we present a case in which the patient had neuropsychiatric adverse events for almost all kinds of lipid lowering agents (rozuvastatin, atorvastatin, pravastatin, fenofibrate, ezetimibe). Results: A 33-year-old male was admitted to cardiology policlinic with hyperlipidemia disease. He had 235 mg/dl low density lipoprotein levels. Despite of life-style change, LDL-C was decreased to non adequate level of 195 mg/dl. Hypolipidaemic drugs were given by respectively as rozuvastatin, atorvastatin, fenofibrate, pravastatin and ezetimibe. One drug not started until the other drug’s side effects disappear. He had different neuropsychiatric adverse events for different lipid lowering agents. Neuropsychiatric difficulties clear on dechallenge and reappear on rechallenge with almost all kinds of lipid-lowering drugs. Rozuvastatin caused severe headache, visual hallucinations and depression symptoms, atovastatin caused headache and sleep disorders, fenofibrate causeed memory loss and impulse control disorder, pravastatin and ezetimibe caused nightmares. His psychiatric events cleared on after discontinuation lipid lowering drugs. We confirmed the diagnosis of neuropsychiatric adverse events and exclude neuropsychiatric disorders by neurologic and psychiatric examination and cranial imaging methods. Conclusions: Patients with lipid lowering drugs associated adverse events often apply to services with myopathy and hepatotoxicity signs and symptoms; therefore clinicians bypass other rare side events, as in our case. Also very rare side effects cause patients to be misled and receive the wrong approaching techniques and treatments. Despite the importance of neuropsychiatric adverse events of lipid lowering drugs, the exact causes have not yet been established. PP-104 PREGNANCY FOLLOWED BY DELIVERY MAY AFFECT CIRCULATING SOLUBLE LECTIN-LIKE OXIDIZED LOW-DENSITY LIPOPROTEIN RECEPTOR-1 LEVELS IN WOMEN OF REPRODUCTIVE AGE M. Balin, A. Celik, ¸ M.A. Kobat. Elazig Education and Research Hospital, Elazig, Turkey Objective: The incidence of coronary artery disease (CAD) and mortality is very low in women of reproductive age. It is known that menopause or lack of endogenous estrogen is a risk factor for endothelial dysfunction and CAD. Lectin-Like Oxidized LowDensity Lipoprotein Receptor-1 (LOX-1) is involved in multiple phases of vascular dysfunction, including endothelial dysfunction, atherosclerotic plaque formation and destabilization. The purpose of the current study was to determine the association between soluble LOX-1 (sLOX-1) and pregnancy followed by delivery in women of reproductive age.
S133
Methods: Sixty-eight subjects with pregnancy followed by delivery (Group 1) and 57 subjects with non-gravidity (Group 2) were included in this study. Levels of sLOX-1 were measured in serum by ELISA. Results: Plasma levels of sLOX-1 were significantly higher in Group 1 than Group 2 in women of reproductive age (0.78±0.13 ng/mL and 0.52±0.18 ng/mL, respectively, p < 0.001). There were highly correlation between sLOX-1 levels and number of gravid (r = −0.645, p < 0.001). The levels of sLOX-1 highly correlated with number of parous (r = −0.683, p < 0.001). Conclusions: Our study demonstrated that serum sLOX-1 levels were associated with pregnancy followed by delivery that might predict endothelial dysfunction. Pregnancy followed by delivery may improve endothelial function and prevent the progress of atherosclerosis in women of reproductive age. We conclude that pregnancy followed by delivery may delay the beginning and progress of arteriosclerosis and its clinical manifestations in women of reproductive age. PP-105 A RARE CAUSE OF ISCHEMIC DILATED CARDIOMYOPATHY IN CHILDHOOD: FAMILIAL HYPERCHOLESTEROLEMIA M. Keskin, U.A. Orun, O. Ceylan, S. Ozgur, V. Dogan, S. Karademır. Dr. Sami Ulus Children’s Health and Diseases Training and Research Hospital, Ankara, Turkey Results: Dilated cardiomyopathy in childhood is often idiopathic, and it has high morbidity and mortality rates. On the contrary, ischemic dilated cardiomyopathy as a result of premature atherosclerosis and coronary artery disease caused by familial hyprecholesterolemia is quite rare in childhood. It usually manifests itself in the second decade of life. We present a male patient aged 11 years and 9 months who was admitted to our clinic with the complaints of palpitation, easy tiredness and weakness. He had been followed up with the diagnosis of familial hypercholesterolemia type 2a for two years, and had used ezetimibe and atorvastatin irregularly besides plasmapheresis sessions performed with irregular intervals. His mother had also been followed up with the diagnosis of heterozygous hypercholesterolemia. Physical examination revealed xanthomas in the legs and on the extensor surfaces of the arms. In the echocardiography, hyperechogeneity in the aortic valve and in the region where the coronary arteries exit due to calcification causing narrowing of the outlet of the coronary arteries, dilated left ventricles and excessively disturbed left ventricular functions were noted. End-diastolic diameter of the left ventricle, ejection fraction and shortening fraction were 52 mm, 35% and 16%, respectively. Serum total cholesterol, LDL cholesterol and triglyceride levels were 570 mg/dl, 513 mg/dl and 125 mg/dl, respectively. In angiography, 50% narrowing of the bifurcation of the left coronary artery and irregularity in the wall of ascending aorta were seen. In the light of these findings, it was thought that dilated cardiomyopathy developed secondary to ischemic damage. Ezetimibe and atorvastatin were initiated again, and low-fat diet, enalapril and furosemide against heart failure were recommended. Total cholesterol and LDL cholesterol levels started to decrease with regular antilipid treatment, so plasmapheresis was not indicated. The importance of the treatment was explained to the parents. Conclusions: We want to emphasize that dilated cardiomyopathy may develop as a result of ischemia in children with hypercholesterolemia early in their life, and that these cases should be followed up closely keeping in mind the possible development of cardiac complications.