scholarly journals Increased Atherothrombotic Burden in Patients with Diabetes Mellitus and Acute Coronary Syndrome: A Review of Antiplatelet Therapy

2012 ◽  
Vol 2012 ◽  
pp. 1-18 ◽  
Author(s):  
Karthik Balasubramaniam ◽  
Girish N. Viswanathan ◽  
Sally M. Marshall ◽  
Azfar G. Zaman
Keyword(s):  
Diabetes Mellitus ◽  
Acute Coronary Syndrome ◽  
Platelet Inhibition ◽  
Cardiovascular Complications ◽  
Diabetic Patients ◽  
Coronary Syndrome ◽  
Patients With Diabetes ◽  
Thrombotic Complications ◽  
Underlying Pathophysiology ◽  
Ischemic Events

Patients with diabetes mellitus presenting with acute coronary syndrome have a higher risk of cardiovascular complications and recurrent ischemic events when compared to nondiabetic counterparts. Different mechanisms including endothelial dysfunction, platelet hyperactivity, and abnormalities in coagulation and fibrinolysis have been implicated for this increased atherothrombotic risk. Platelets play an important role in atherogenesis and its thrombotic complications in diabetic patients with acute coronary syndrome. Hence, potent platelet inhibition is of paramount importance in order to optimise outcomes of diabetic patients with acute coronary syndrome. The aim of this paper is to provide an overview of the increased thrombotic burden in diabetes and acute coronary syndrome, the underlying pathophysiology focussing on endothelial and platelet abnormalities, currently available antiplatelet therapies, their benefits and limitations in diabetic patients, and to describe potential future therapeutic strategies to overcome these limitations.

Ticagrelor versus prasugrel in diabetic patients with an acute coronary syndrome

2014 ◽  
Vol 111 (02) ◽  
pp. 273-278 ◽  
Author(s):  
Marc Laine ◽  
Corinne Frere ◽  
Richard Toesca ◽  
Julie Berbis ◽  
Pierre Barnay ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Acute Coronary Syndrome ◽  
Platelet Reactivity ◽  
Statistical Significance ◽  
Randomised Trial ◽  
Diabetic Patients ◽  
Loading Dose ◽  
Open Label ◽  
Coronary Syndrome ◽  
Patients With Diabetes

SummaryOptimal P2Y12 receptor blockade is critical to prevent ischaemic recurrence in patients undergoing percutaneous coronary intervention (PCI). We aimed to compare the level of platelet reactivity (PR) inhibition achieved by prasugrel and ticagrelor loading dose (LD) in diabetic acute coronary syndrome (ACS) patients undergoing PCI. We performed a single-center prospective open-label randomised trial. Patients with diabetes mellitus undergoing PCI for an ACS were randomised to receive prasugrel 60 mg or ticagrelor 180 mg. The primary endpoint of the study was the level of platelet reactivity (PR) assessed between 6 and 18 hours post-LD using the VASP index. We randomised 100 diabetic patients undergoing PCI for an ACS. No difference was observed in baseline characteristics between the two groups. In particular, the rate of patient receiving insulin therapy was identical (25 vs 28.6%; p =0.7). Ticagrelor achieved a significantly lower PR compared to prasugrel loading dose (17.3 ± 14.2 vs 27.7 ± 23.3%; p=0.009). In addition the rate of high on-treatment platelet reactivity, defined by a VASP ≥50%, tend to be lower in the ticagrelor group although the difference did not reach statistical significance (6 vs 16%; p=0.2). The rate of low on treatment PR was identical (60 vs 54%; p=0.8). The present study demonstrates that ticagrelor LD is superior to prasugrel LD to reduce PR in ACS patients with diabetes mellitus. Whether the higher potency of ticagrelor could translate into a clinical benefit should be investigated.

scholarly journals Predictive value of the N-terminal prohormone of brain natriuretic peptide in the long-term prognosis of ventricular arrhythmia in diabetic patients with acute coronary syndrome of young and middle age

2020 ◽  
Vol 43 (4) ◽  
pp. 522-538
Author(s):  
Zheming Wang ◽  
◽  
Elena A. Asafieva ◽  
Tatiana I. Makeeva ◽  
◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Acute Coronary Syndrome ◽  
Ventricular Arrhythmia ◽  
Natriuretic Peptide ◽  
Middle Age ◽  
Diabetic Patients ◽  
Coronary Syndrome ◽  
Patients With Diabetes ◽  
Long Term Prognosis

The article investigates the prognostic value of pro-B-type N-terminal natriuretic peptide (NTproBNP) in connection with ventricular extrasystoles (VES) in a population of patients with diabetes mellitus with acute coronary syndrome (ACS) after successful coronary reperfusion by percutaneous coronary intervention (PCI). Patients with ACS were examined by defining biomarkers and performing echocardiography (EchoCG) on the first day of ACS after PCI with stenting of the infarction-related coronary artery, and Holter monitoring of electrocardiography (HM-ECG) on the second day after PCI; 12 months later, EchoCG, HM-ECG and NT-proBNP determination were repeated. It was found that the incidence of VES in the long-term prognosis among ACS patients with diabetes of young and middle age was more frequent than in patients without diabetes. A positive correlation was found between the NTproBNP level and ventricular arrhythmia in ACS patients with diabetes mellitus. It has been proven that a high level of NT-proBNP on the first day in patients with ACS after PCI as an independent indicator of risk to development of VES in long-term prognosis.

scholarly journals Ischemic and Bleeding Events of Ticagrelor Monotherapy in Korean Patients With and Without Diabetes Mellitus: Insights From the TICO Trial

2021 ◽  
Vol 11 ◽  
Author(s):  
Kyeong Ho Yun ◽  
Jae Young Cho ◽  
Seung Yul Lee ◽  
Sang Jae Rhee ◽  
Byeong Keuk Kim ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Myocardial Infarction ◽  
Academic Research ◽  
Bleeding Complications ◽  
Diabetic Patients ◽  
Bleeding Events ◽  
Coronary Syndrome ◽  
Patients With Diabetes ◽  
The Impact ◽  
Ischemic Events

Background: Ticagrelor monotherapy after 3 months dual antiplatelet therapy (DAPT) with aspirin and ticagrelor can reduce bleeding without increasing ischemic events after percutaneous coronary intervention (PCI). However, the impact of this approach among the patient with diabetes remains unknown.Methods: This was a sub-analysis of the Ticagrelor Monotherapy after 3 months in the Patients Treated with New Generation Sirolimus Eluting Stent for Acute Coronary Syndrome (TICO) trial. After successful PCI, the patients were randomly assigned to ticagrelor monotherapy after 3-months DPAT or to ticagrelor-based 12-months DAPT. We compared ischemic events and bleeding events between the patients with diabetes and without diabetes for 12 months. Ischemic events were defined as death, myocardial infarction, ischemic stroke, transient ischemic attack, stent thrombosis, and any revascularizations. Bleeding events were defined according to the Thrombolysis in Myocardial Infarction (TIMI) criteria and Bleeding Academic Research Consortium (BARC) definition.Results: Between August 2015 and October 2018, 3,056 patients were enrolled in the TICO trial, of which 835 (27.3%) had diabetes mellitus. Diabetes mellitus was associated with all evaluated ischemic and bleeding events. No significant differences in any ischemic events were observed in patients with diabetes between ticagrelor monotherapy after 3-months DAPT and ticagrelor-based 12-months DAPT (hazard ratio [HR] 0.83, 95% confidence interval [CI] 0.45–1.52, p = 0.540). In patients with diabetes, the overall incidence of bleeding complications during the 12-months follow-up period did not differ between the two treatment groups (HR 0.83, 95% CI 1.48–1.43, p = 0.505). However, ticagrelor monotherapy was significantly reduced both any TIMI bleeding and BARC three or five bleeding events in diabetes patients in the 3-months landmark analysis, after 3-months DAPT period (HR 0.20, 95% CI 0.07–0.59, p = 0.003).Conclusion: In diabetic patients, ticagrelor monotherapy showed a lower incidence of bleeding complications after 3-months DAPT period, without increasing ischemic complications, compared with ticagrelor-based 12-months DAPT (ClinicalTrials.gov Identifier: NCT02494895).

scholarly journals In-Hospital Outcome Of Acute Coronary Syndrome In Patients With Diabetes Mellitus

2009 ◽  
Vol 5 (1) ◽  
pp. 24-27
Author(s):  
Dilip Kumar Sarker ◽  
KMHS Sirajul Haque ◽  
Md Abu Siddique ◽  
Md Khurshed Ahmed ◽  
Fazlur Rahman ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Heart Failure ◽  
Congestive Heart Failure ◽  
Acute Coronary Syndrome ◽  
Hospital Mortality ◽  
Cardiogenic Shock ◽  
Diabetic Patients ◽  
Coronary Syndrome ◽  
Recurrent Angina ◽  
Patients With Diabetes

Diabetes mellitus adversely influences the outcome of acute coronary syndrome. This study evaluated the in-hospital outcome of acute coronary syndrome in patients with diabetes mellitus. In this prospective observation study 130 patients with acute coronary syndrome were enrolled. They were divided into diabetic and nondiabetic group. Diabetic patients were taken as case and nondiabetic patients as control. Outcome parameter studied were in-hospital mortality, cardiogenic shock, congestive heart failure, different arrhythmias and recurrent angina. In this study, one third (32%) of the patients were diabetic with mean age 58±10.0 years vs. 53.0±13.6 years in diabetic and nondiabetic group, respectively. Majority of the patients in both groups were male. Congestive heart failure and arrhythmias were more common in case group compared to those in control group (19% vs. 13.6% p=0.424; 23.8% vs. 13.6%, p= 0.148, respectively). Cardiogenic shock developed in 7.1% of diabetic patients and 8% of nondiabetic patients. In hospital mortality was 7.1% and 5.7% in diabetic and nondiabetic group, respectively. Recurrent angina developed only in diabetic patients. Therefore, diabetic patients with acute coronary syndrome encountered more in- hospital adverse outcome.   doi: 10.3329/uhj.v5i1.3437 University Heart Journal Vol. 5, No. 1, January 2009 24-27

scholarly journals Association between Serum Magnesium Level with Acute Coronary Syndrome (ACS) in Diabetes Mellitus (DM) Patients

2019 ◽  
Vol 2 (2) ◽  
pp. 96
Author(s):  
Ratih Wulansari ◽  
Soebagijo Adi Soelistijo ◽  
Achmad Lefi
Keyword(s):  
Diabetes Mellitus ◽  
Acute Coronary Syndrome ◽  
Plaque Rupture ◽  
Serum Magnesium ◽  
Demographic Data ◽  
Cardiovascular Complications ◽  
Magnesium Level ◽  
Serum Magnesium Level ◽  
Coronary Syndrome ◽  
Normally Distributed

Introduction: Until now, cardiovascular complications are still the highest cause of death and disability in DM patients. Hypomagnesemia in DM accelerate atherosclerosis and can cause instability and plaque rupture which can lead to acute coronary syndrome.Methods: Design of this study was observational analytic using a "case control" study involved 76 samples of DM patients, consisting of 38 samples with SKA (+) and 38 samples with SKA (-). Subjects of this study were all DM patients in the period July-December 2018 in the Emergency Room (ER) and Outpatient Installation of Endocrine at the RSUD Dr. Soetomo Surabaya, which fulfills the criteria for inclusion and exclusion. Demographic data and clinical characteristics are presented descriptively. If data is normally distributed then an unpaired t test is carried out and if the data is not normally, distributed with Mann Whitney test is performed. The statistical test was stated to be significant if p <0.05. The association between hypomagnesemia and the incidence of ACS a multivariate logistic regression test was performed, the risk number was in the form of odds ratios (OR). Results: This study involved 76 subjects with diabetes mellitus with SKA and non SKA 38 subjects. The mean serum magnesium level in the ACS group was lower than non ACS (1.9 mg / dL vs. 2.1 mg / dL), hypomagnesemia cut-off of <2.08 mg / dL. In this study hypomagnesemia as a risk factor for the incidence of ACS in DM patients with OR 2.8 (CI 1.1-7.6; p = 0.039).Conclusion: Magnesium levels in the ACS group were lower than the non ACS group. Hypomagnesemia Increase The Incidence of Acute Coronary Syndrome in Diabetes Mellitus Patients.

Physical Activity Frequency on the 10-Year Acute Coronary Syndrome (ACS) Prognosis; The Interaction With Cardiovascular Disease History and Diabetes Mellitus: The GREECS Observational Study

2016 ◽  
Vol 24 (4) ◽  
pp. 624-632 ◽  
Author(s):  
Evangelos Papataxiarchis ◽  
Demosthenes B. Panagiotakos ◽  
Venetia Notara ◽  
Matina Kouvari ◽  
Yannis Kogias ◽  
...  
Keyword(s):  
Physical Activity ◽  
Diabetes Mellitus ◽  
Acute Coronary Syndrome ◽  
Protective Effect ◽  
Protective Factor ◽  
Monthly Basis ◽  
Coronary Syndrome ◽  
Activity Frequency ◽  
Patients With Diabetes ◽  
Greek Hospitals

The association between physical activity, diabetes mellitus (DM), and long-term acute coronary syndrome (ACS) prognosis was evaluated. The GREECS study included 2,172 consecutive ACS patients from six Greek hospitals (2003–2004). In 2013–2014, a 10-year follow up was performed with 1,918 patients. Physical activity was categorized in never, rarely (monthly basis), 1–2 and ≥ 3 times/week. Multi-adjusted analysis revealed that 1–2 and ≥ 3 times/week vs. no physical activity had a protective effect on ACS incidence (OR = 0.63 95% CI 0.38, 1.05) and (OR = 0.63 95% CI 0.40, 0.99) respectively, only in patients without prior baseline CVD event. In a subgroup analysis, with DM as strata in these patients, engagement in physical activity (i.e., 1–2 times/week) had a significant protective effect among patients with diabetes (OR = 0.51, 95% CI 0.27, 0.96, p = .037). These findings revealed the beneficial role of exercise in secondary ACS prevention, even in DM patients. Public health-oriented policies should incorporate regular physical activity as a key protective factor in disease prognosis.

DYSLIPIDEMIA – TYPE2 DIABETES AND NON DIABETES POPULATION IN AND AROUND ERODE DISTRICT, TAMILNADU

2021 ◽  
pp. 8-9
Author(s):  
Murugesan Thinakaran ◽  
Thangadurai Chitra
Keyword(s):  
Diabetes Mellitus ◽  
Cardiovascular Complications ◽  
Diabetic Patients ◽  
Type 2 Diabetic Patients ◽  
Lipid Status ◽  
Type2 Diabetes ◽  
Patients With Diabetes ◽  
Tertiary Hospitals ◽  
Low Hdl

Background and objects: Patients with diabetes mellitus are at high risk of cardiovascular events because of abnormal lipid status. Dyslipidemia is common in diabetes mellitus and is associated with cardiovascular complications. Early diagnosis and treatment is the main cornerstone in the prevention of its multiple complications. The aim of the study was to determine the prevalence of abnormal lipid prole levels. Materials and Method: The study population was made up of Eighty-ve (85) already diagnosed type 2 diabetic patients and Ninety-two (92) with an age range of 28 to 70 years, who come from routine health, follow up at various tertiary hospitals in Erode. The samples were analyzed using the chemical analyzer COBAS INTEGRA 400. Results and Conclusion: Dyslipidemia was found in 63.52% in type2 diabetes patients and 43.47% in non-diabetic patients. High TG, high LDL-C, high TC and low HDL-C exhibited an increasing trend in the proportion of patients with dyslipidemia. The following risk factors namely female sex, age above 50- years, BMI (overweight and obese), poor glycemic control, central obesity and physical inactivity were associated with diabetic dyslipidemia. This study presents some interesting and novel ndings which may be very important in the care and management of patients with type-2 diabetes.

P3606Impact of diabetes mellitus on the selection of antiplatelet treatment and medium-term prognosis after acute coronary syndrome

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
L Nunez Martinez ◽  
N V-Ibarra ◽  
F Marin Ortuno ◽  
V Pernias Escrig ◽  
M Sandin Rollan ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Acute Coronary Syndrome ◽  
Antiplatelet Therapy ◽  
Coronary Disease ◽  
Cardiovascular Events ◽  
Diabetic Patients ◽  
Medium Term ◽  
Coronary Syndrome ◽  
Diabetic Population ◽  
One Year

Abstract Introduction Patients with diabetes mellitus (DM) have a higher atherothrombotic risk and higher rates of recurrent ischemic events compared with the non-diabetic population. Although current antiplatelet therapy strategies have been shown to be successful in improving outcomes in acute coronary syndrome (ACS), patients with DM continue to experience high rates of adverse cardiovascular events. Today, it is known that diabetic patients are characterized by a deregulation in different intracellular signaling pathways, which leads to an inadequate or suboptimal response to antiplatelets agents. The purpose of this study is to analyze the different therapeutic strategies, the use of new antiplatelet drugs and medium-term prognosis in diabetic patients compared with non-diabetic patients who have suffered an ACS. Methods It is an observational, prospective and multicenter registry of patients with ACS. The objective is to analyze the differences in the management of DM patients vs non-DM patients in the acute phase and their evolution during the first year after coronary event. Antiplatelet therapy administered will be evaluated, type of coronary injury and treatment performed, major adverse events as well as cardiovascular complications and mortality at one year of follow-up. Results Of a total of 1717 patients, 38% were diabetic. The diabetic population was older, with a higher prevalence of cardiovascular risk factors and higher rate of previous cardiovascular events (cerebrovascular, peripheral arterial disease and coronary disease). Patients with DM received less new antiplatelets drugs at admission (15.5% DM vs 26.5% non DM, p<0.001) and less in-hospital switch to new antiplatelet agents was performed. They were subjected to a lower number of catheterizations and at the time of revascularization, the drug-eluting stent was of choice. During admission, they developed more complications, both ischemic (refractory angina, reinfarction or CVA) and hemorrhagic. Following one year, DM had higher major cardiovascular events (MACE) and higher mortality (7.72% vs 5.14%, p=0.0039). Non-coronary revascularization, renal failure, and reduced ejection fraction were predictive variables of death in diabetic population. Treatment with new antiplatelet drugs was associated with a statistically significant decrease in total mortality an MACE without differences in major bleeding. Conclusion More than a third of patients with ACS are diabetic. These patients present with more severe coronary disease associating a greater number of cardiovascular events and a higher mortality rate after one year of ACS. However, despite this, they undergo less invasive tests and they were undertreated with the new antiplatelets therapies. Acknowledgement/Funding SEC

The structural and functional changes of blood cells and molecular components in diabetes mellitus

2017 ◽  
Vol 398 (4) ◽  
pp. 411-423 ◽  
Author(s):  
Leszek Szablewski ◽  
Anna Sulima
Keyword(s):  
Diabetes Mellitus ◽  
Red Blood Cells ◽  
Blood Cells ◽  
White Blood Cells ◽  
Neutrophil Function ◽  
Cardiovascular Complications ◽  
Oxygen Binding ◽  
Functional Changes ◽  
Coronary Syndrome ◽  
Patients With Diabetes

Abstract It is known fact that diabetes mellitus (DM) affects blood cells. Changes in the erythrocyte membrane, disorder in hemoglobin oxygen-binding and modification in mechanical characteristics, are effects of hyperglycemia on red blood cells. Altered susceptibility infection of patients with diabetes has been ascribed to a depression in the function of polymorphonuclear leukocytes. Neutrophil function in patients with diabetes with good glucose control is slightly different than in healthy ones. DM causes significant changes in lymphocytes metabolism and their functions. Patients with diabetes, presenting with acute coronary syndrome, are at higher risk of cardiovascular complications and recurrent ischemic events in comparison to non-diabetic counterparts. Various mechanisms, including endothelial dysfunction, platelet hyperactivity, and abnormalities in coagulation and fibrynolysis have been implicated for this increased atherothrombotic risk. There are many other alterations of blood cells due to DM. In the present review we focused on modifications of blood cells due to DM. Then, as a second point, we explored how the changes affect functions of red blood cells, white blood cells and platelets.

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