scholarly journals Diabetes Mellitus and Cardiovascular Prevention: The Role and the Limitations of Currently Available Antiplatelet Drugs

2011 ◽  
Vol 2011 ◽  
pp. 1-5 ◽  
Author(s):  
A. Tufano ◽  
E. Cimino ◽  
M. N. D. Di Minno ◽  
P. Ieranò ◽  
E. Marrone ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Secondary Prevention ◽  
Cardiovascular Events ◽  
Microvascular Complications ◽  
Cardiovascular Prevention ◽  
Antiplatelet Drugs ◽  
Diabetic Patients ◽  
Primary And Secondary Prevention ◽  
Vascular Events

Diabetes mellitus (DM) is associated with macrovascular and microvascular complications. Platelets have a “key role” in atherogenesis and its thrombotic complications in subjects with DM. Moreover, the concomitant presence of multiple “classical” cardiovascular risk factors in diabetic subjects contributes to enhanced atherothrombotic risk. Antiplatelet agents are effective in primary and secondary prevention of arterial thrombosis (cardiovascular events, ischaemic stroke, and peripheral arterial occlusive disease). The role of chronic administration of antiplatelet drugs in primary prevention of arterial vascular events is known to be less clear than in secondary prevention, and, also in diabetic patients, the decision to give primary prophylaxis should be taken on an individual-patient basis, after a careful evaluation of the balance between the expected benefits and the risk of major bleedings. Although, currently, treatment has proven useful in reducing vascular events, diabetic patients continue to have a higher risk of adverse cardiovascular events compared with those in nondiabetic patients. This paper reviews the role of currently available antiplatelet drugs in primary and secondary prevention of vascular events in diabetic patients and the limitations of these drugs, and it discusses the role of novel and more potent antiplatelets and of new agents currently under clinical development.

Role of ASA in the primary and secondary prevention of cardiovascular events

2012 ◽  
Vol 26 (2) ◽  
pp. 113-123 ◽  
Author(s):  
Rubén Casado-Arroyo ◽  
Fatih Bayrak ◽  
Andrea Sarkozy ◽  
Gian-Battista Chierchia ◽  
Carlo de Asmundis ◽  
...  
Keyword(s):  
Secondary Prevention ◽  
Cardiovascular Events ◽  
Primary And Secondary Prevention

Is aspirin still the drug of choice for management of patients with peripheral arterial disease?

VASA ◽  
2013 ◽  
Vol 42 (2) ◽  
pp. 88-95 ◽  
Author(s):  
Pavel Poredos ◽  
Mateja K. Jezovnik
Keyword(s):  
Cardiovascular Events ◽  
Meta Analysis ◽  
Ankle Brachial Index ◽  
Arterial Disease ◽  
Antiplatelet Drugs ◽  
Antiplatelet Drug ◽  
Diabetic Patients ◽  
Vascular Events ◽  
Artery Disease ◽  
Peripheral Arterial

Antiplatelet drugs represent one of the basic options for management of patients with different atherosclerotic diseases. Aspirin is the oldest and most often prescribed antiplatelet drug. The efficacy of aspirin depends on the clinical characteristics of the treated population and probably also on the type or location of atherosclerotic disease. It seems that it is most effective in coronary patients with clinically unstable disease, less effective in prevention of cerebrovascular incidents, and its efficacy is uncertain in peripheral artery disease (PAD) patients. One of the first meta-analyses (Antithrombotic Trialists’ Collaboration - ATC) indicated that antiplatelet drugs also significantly reduce cardiovascular events in patients with PAD. However, only one third of the PAD patients included were treated with aspirin, while the rest received other anti-platelet drugs. The latest ATC meta-analysis of randomized control trials of aspirin therapy involving patients with diabetes and PAD demonstrated no benefit of aspirin in reducing cardiovascular events. Also in patients with preclinical PAD (pathological ankle brachial index) aspirin did not result in a significant reduction of vascular events. The new anti-platelet drugs prasugrel, ticagrelor and picotamide seem to be more effective than aspirin in PAD patients, particularly in diabetic patients with PAD. In conclusion, antiplatelet drugs are effective in prevention of cardiovascular events in different atherosclerotic diseases, including PAD. However, recent studies indicated that in PAD patients aspirin is less effective than in coronary artery disease. New anti-platelet drugs showed marginal superiority over aspirin without definite advantages. Aspirin thus remains the first line of antiplatelet drug for secondary prevention of cardiovascular events in PAD patients and clopidogrel as its effective alternative. Further, new studies on PAD patients are necessary to better define the role of anti-platelet agents in these patients and one of the promising ways of access to anti-platelet treatment would be personalized anti-platelet therapy.

Antithrombotic Treatment in Diabetes Mellitus: A Review of the Literature about Antiplatelet and Anticoagulation Strategies Used for Diabetic Patients in Primary and Secondary Prevention

2020 ◽  
Vol 26 (23) ◽  
pp. 2780-2788 ◽  
Author(s):  
Gerasimos Siasos ◽  
Georgia Skotsimara ◽  
Evangelos Oikonomou ◽  
Marios Sagris ◽  
Mystakidi Vasiliki-Chara ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Secondary Prevention ◽  
Triple Therapy ◽  
Critical Role ◽  
Bleeding Complications ◽  
Diabetic Patients ◽  
Primary And Secondary Prevention ◽  
Cvd Risk ◽  
Myocardial Infraction ◽  
Diabetic Population

Background: Diabetes mellitus (DM) is on the rise globally. Its prevalence has nearly doubled during the last two decades and it is estimated to affect 8.8% of the global population. Cardiovascular disease (CVD) is the leading cause of death in diabetic population and despite modern anti-inflammatory and cardioprotective therapeutic strategies diabetic patients have at least a twice fold risk of cardiovascular events. Prothrombotic state in DM is associated with multiple determinants such as platelet alterations, oxidative stress, endothelial changes, circulating mediators. Thus, proper antithrombotic strategies to reduce the risk of CVD in this population is critical. Methods: This article reviews the current antiplatelet and anticoagulant agents in the aspect of primary and secondary prevention of CVD in the diabetic population. Results: The use of aspirin may be considered only at high-risk patients in the absence of contraindications. Cangrelor was not inferior to clopidogrel in preventing the composite outcome of CV death, myocardial infraction and revascularization without increasing major bleeding. Triple therapy in the subpopulation with DM significantly reduced the composite primary outcome of CV death, myocardial infraction or repeat target lesion revascularization. That was not the case for stent thrombosis, which was similar in both groups. Importantly, triple therapy did not result in increased bleeding complications, which were similar in both groups. However, cilostazol is linked to various adverse effects (e.g., headache, palpitations, and gastrointestinal disturbances) that drive many patients to withdrawal. Conclusion: In conclusion, DM is a rapidly growing disease that increases the risk of CVD, AF, and CV mortality. Proper antithrombotic strategies to reduce CVD risk in DM is a necessity. Also, new antithrombotic treatments and combination therapies may play a critical role to overcome antiplatelet resistance in DM patients and reduce morbidity and mortality attributed to CVD.

scholarly journals Olfactory Dysfunction: A Complication of Diabetes or a Factor That Complicates Glucose Metabolism? A Narrative Review

2021 ◽  
Vol 10 (23) ◽  
pp. 5637
Author(s):  
Evanthia Gouveri ◽  
Nikolaos Papanas
Keyword(s):  
Diabetes Mellitus ◽  
Peripheral Neuropathy ◽  
Energy Balance ◽  
Glucose Metabolism ◽  
Microvascular Complications ◽  
Diabetic Complication ◽  
Olfactory Dysfunction ◽  
Narrative Review ◽  
Central Neuropathy

The present narrative review presents emerging data regarding the association between diabetes mellitus and olfactory dysfunction and discusses the role of olfactory dysfunction in glucose metabolism. We searched relevant published articles in PubMed and Google Scholar until October 2021. Main key words included “olfactory dysfunction”, “diabetes mellitus”, and “glucose metabolism”. Olfactory dysfunction has been associated with diabetes mellitus. Furthermore, it has been proposed to be a diabetic complication, given that it has been linked with microvascular complications, such as diabetic peripheral neuropathy. Interestingly, it has been suggested that olfactory dysfunction is a manifestation of central neuropathy in diabetes, a hypothesis based on the observation that diabetes, olfactory dysfunction, and cognitive decline often coexist. However, evidence is limited and inconsistent. More importantly, olfactory and endocrine systems are closely linked, and olfactory dysfunction plays a significant role in glucose metabolism and obesity. Indeed, food behaviour and energy balance are influenced by olfaction status.

scholarly journals The Role of C-reactive Protein in Patient Risk Stratification and Treatment

2021 ◽  
Vol 16 ◽  
Author(s):  
Ramón Arroyo-Espliguero ◽  
María C Viana-Llamas ◽  
Alberto Silva-Obregón ◽  
Pablo Avanzas
Keyword(s):  
Risk Stratification ◽  
Cardiovascular Events ◽  
Specific Treatment ◽  
Cardiovascular Prevention ◽  
Chronic Inflammatory Disease ◽  
Residual Risk ◽  
C Reactive Protein ◽  
Inflammatory Biomarker ◽  
Reactive Protein

Atherosclerosis is a chronic inflammatory disease. Several circulating inflammatory markers have been proposed for clinical use due to their ability to predict future cardiovascular events and may be useful for identifying people at high risk who might benefit from specific treatment to reduce this risk. Moreover, the identification of new therapeutic targets will allow the development of drugs that can help reduce the high residual risk of recurrence of cardiovascular events in patients with coronary artery disease. The clinical benefits of reducing recurrent major cardiovascular events recently shown by canakinumab and colchicine have renewed the cardiology community’s interest in inflammation as an aetiopathogenic mechanism for atherosclerosis. This review explores the use of C-reactive protein, which is the most frequently studied biomarker in this context; the concept of residual risk in primary and secondary cardiovascular prevention; and the current recommendations in international guidelines regarding the role of this inflammatory biomarker in cardiovascular risk stratification.

scholarly journals To study levels of serum fibrinogen in type 2 diabetes mellitus and its association with diabetic microvascular complications

2017 ◽  
Vol 4 (1) ◽  
pp. 10
Author(s):  
Gurinder Mohan ◽  
Ranjeet Kaur ◽  
Aakash Aggarwal ◽  
Parminder Singh
Keyword(s):  
Diabetes Mellitus ◽  
Microvascular Complications ◽  
Vascular Complications ◽  
High Serum ◽  
Diabetic Patients ◽  
Coagulation Disorder ◽  
Urine Albumin ◽  
Group A ◽  
Diabetic Microvascular Complications ◽  
Group B

Background: Diabetes mellitus is a hypercoagulable state associated with atherosclerosis leading to development of vascular complications, including microvascular complications.Methods: In our study a total of 60 diabetic patients with duration of diabetes more than 5 years, attending the OPD/ indoor of SGRDIMSR, Amritsar, Punjaqqb, India were included. They were divided in two groups, group A of 30 patients including diabetics with any of the three microvascular complications (diabetic nephropathy, diabetic retinopathy and diabetic neuropathy) and group B of 30 patients including diabetics without any microvascular complication. Group C comprised of 30 age and sex matched non-diabetic subjects who served as controls. Subjects with liver cirrhosis, malignancy or coagulation disorder were excluded. After taking the consent, detailed history taking and detailed physical examination and relevant investigations were done. The serum fibrinogen (hemostasis marker), HBA1C and UACR (urine albumin creatinine ratio) along with routine investigations were measured.Results: It was observed that serum fibrinogen levels were significantly higher in diabetic patients (266.16±54.73 mg/dl) as compared to non-diabetic controls (174.66±18.32 mg/dl); p <0.001.Further, serum fibrinogen levels were found to be significantly higher in diabetic patients with microvascular complications (293.43±51.09 mg/dl) as compared to those without microvascular complications (238.90±44.12); p<0.001.Conclusions: Significantly high serum fibrinogen level was found in diabetic patients as compared to controls and was in positive correlation with development of microvascular complications.

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