Prevention of cardiovascular disease in type-2 diabetes: How to improve the clinical efficacy of aspirin

2005 ◽  
Vol 93 (01) ◽  
pp. 8-16 ◽  
Author(s):  
Licia Totani ◽  
Serenella Rotondo ◽  
Roberto Lorenzet ◽  
Gianni Tognoni ◽  
Giorgia De Berardis ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Primary Prevention ◽  
Clinical Efficacy ◽  
Diabetic Patients ◽  
Atherosclerotic Cardiovascular Disease ◽  
Low Dose Aspirin ◽  
Patients With Diabetes ◽  
Thrombotic Complications ◽  
Antithrombotic Efficacy

SummaryAtherosclerotic cardiovascular disease and its thrombotic complications are the principal causes of morbidity and mortality in patients with type-2 diabetes.Aspirin reduces the risk of thrombotic events in a broad range of patients with vascular disease and, in selected individuals, is beneficial for primary prevention. Although recommended by existing guidelines,in secondary and in primary prevention trials the clinical efficacy of low-dose aspirin in patients with diabetes appears to be substantially lower than in individuals without diabetes. In this review, we discuss possible mechanisms that may contribute to reduce the antithrombotic activity of aspirin in diabetes.We also discuss adjuvant therapies used in diabetic patients that may potentially improve the antithrombotic efficacy of aspirin.

scholarly journals Role of Aspirin for primary prevention of cardiovascular and all-cause mortality events in diabetes: An updated meta-analysis of randomized controlled trials.

2021 ◽  
Author(s):  
Hua Ma ◽  
QIng Gu ◽  
Huining Niu ◽  
Xiaohua Li ◽  
Rong Wang
Keyword(s):  
Cardiovascular Disease ◽  
Primary Prevention ◽  
Meta Analysis ◽  
Significant Risk ◽  
Diabetic Patients ◽  
Primary Endpoints ◽  
All Cause Mortality ◽  
Patients With Diabetes ◽  
Rule Out

Background: The use of Aspirin in the primary prevention of cardiovascular disease (CVD) is still a topic of debate, especially in patients with diabetes. The present meta-analysis aims to rule out the efficacy of Aspirin in patients with diabetes and to compare the effectiveness of Aspirin with a placebo (or no treatment) for the primary prevention of CVD and all-cause mortality events in people with diabetes. Materials and Methods: An extensive and systematic search was conducted in Medline (via PubMed), Cinahl (via Ebsco), Scopus, and Web of Sciences from 1988 to December 2020. A detailed literature search was conducted using Aspirin, cardiovascular disease (CVD), diabetes, and efficacy to identify trials of patients with diabetes who received Aspirin for primary prevention of CVD. Demographic details with the primary outcome of events and bleeding outcomes were analyzed. The risk of bias (RoB) in included studies was evaluated using the QUADAS-2 tool. Results: A total of 5 studies out of 13 were included with 23,570 diabetic patients; 11,738 allocated to Aspirin and 11,832 allocated to the placebo group. In patients with diabetes, there was no difference between Aspirin and placebo with respect to the risk of all-cause death with a confidence interval (CI) varying 0.63 to 1.17. In addition, there were no differences in the bleeding outcomes with an odds ratio of 1.4411 (CI 0.47 to 4.34). Conclusion: Aspirin has no significant risk on primary endpoints of cardiovascular events and the bleeding outcomes in diabetic patients compared to placebo. More research on the use of Aspirin alone or in combination with other antiplatelet drugs is required in patients with diabetes to supplement currently available research.

scholarly journals 459 Evaluation of LDL-C reductions by siRNA treatment with inclisiran in patients with diabetes mellitus, metabolic syndrome or neither

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
R. Scott Wright ◽  
David Kallend ◽  
Kausik K Ray ◽  
Lawrence Leiter ◽  
Wolfgang Koenig ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Cardiovascular Disease ◽  
Metabolic Syndrome ◽  
Controlled Trial ◽  
Atherosclerotic Cardiovascular Disease ◽  
Double Blind ◽  
Sirna Treatment ◽  
Patients With Diabetes

Abstract Aims Patients with diabetes (DM) and metabolic syndrome (MS) have elevated risks for atherosclerotic cardiovascular disease (ASCVD). Aggressive LDL-C lowering reduces risks. Inclisiran, a new siRNA, lowers LDL-C and was evaluated in patients with Type 2 diabetes (DM), metabolic syndrome (MS) without DM or neither (N) in the ORION-10 trial. Methods ORION-10 was a double-blind, randomized, placebo controlled trial evaluating inclisiran in 1561 patients with ASCVD on maximally tolerated therapy for lowering LDL-C. 781 inclisiran (INC) participants and 780 placebo (P) patients received 1.5 mL SQ tx at Days 1, 90, then every 6 months until Day 540. We evaluated the time adjusted change in LDL-C from baseline after Days 90–540 in DM (n = 702), MS (n = 455) and N participants (n = 404). Results There were no differences in baseline demographics and background therapies between INC and P. Statins were utilized in 89.8% INC and 88.7% of P. High intensity statins were utilized in 67.2% of INC and 68.8% of P; ezetimibe in 10.2% of NC and 9.5% of P participants. INC reduced LDL-C by − 54.4% (−58.3, −50.6 95% CI) in DM, (P < 0.001), −58.6% (−62.3, −54.8), P < 0.001 in-MS and −56.0% (−60.2, −51.7), in N subjects P < 0.001 (see Figure). Conclusions Inclisiran potently and durably reduces LDL-C across patients with DM, MS and those with neither, demonstrating potent efficacy and durability across glycaemic categories. Inclisiran may also represent a potent LDL-C lowering treatment for those with DM and MS.

scholarly journals GIP as a Potential Therapeutic Target for Atherosclerotic Cardiovascular Disease–A Systematic Review

2020 ◽  
Vol 21 (4) ◽  
pp. 1509 ◽  
Author(s):  
Yusaku Mori ◽  
Takanori Matsui ◽  
Tsutomu Hirano ◽  
Sho-ichi Yamagishi
Keyword(s):  
Type 2 Diabetes ◽  
Cardiovascular Disease ◽  
Clinical Trials ◽  
Animal Models ◽  
Hypoglycemic Agents ◽  
Diabetic Patients ◽  
Atherosclerotic Cardiovascular Disease ◽  
Dependent Manner ◽  
Receptor Agonists

Glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) are gut hormones that are secreted from enteroendocrine L cells and K cells in response to digested nutrients, respectively. They are also referred to incretin for their ability to stimulate insulin secretion from pancreatic beta cells in a glucose-dependent manner. Furthermore, GLP-1 exerts anorexic effects via its actions in the central nervous system. Since native incretin is rapidly inactivated by dipeptidyl peptidase-4 (DPP-4), DPP-resistant GLP-1 receptor agonists (GLP-1RAs), and DPP-4 inhibitors are currently used for the treatment of type 2 diabetes as incretin-based therapy. These new-class agents have superiority to classical oral hypoglycemic agents such as sulfonylureas because of their low risks for hypoglycemia and body weight gain. In addition, a number of preclinical studies have shown the cardioprotective properties of incretin-based therapy, whose findings are further supported by several randomized clinical trials. Indeed, GLP-1RA has been significantly shown to reduce the risk of cardiovascular and renal events in patients with type 2 diabetes. However, the role of GIP in cardiovascular disease remains to be elucidated. Recently, pharmacological doses of GIP receptor agonists (GIPRAs) have been found to exert anti-obesity effects in animal models. These observations suggest that combination therapy of GLP-1R and GIPR may induce superior metabolic and anti-diabetic effects compared with each agonist individually. Clinical trials with GLP-1R/GIPR dual agonists are ongoing in diabetic patients. Therefore, in this review, we summarize the cardiovascular effects of GIP and GIPRAs in cell culture systems, animal models, and humans.

scholarly journals Prevalence of Under-Prescription in Elderly Type 2 Diabetic Patients in the Primary Care Unit of a University Hospital

2018 ◽  
Vol 36 (4) ◽  
Author(s):  
Thareerat Ananchaisarp ◽  
Namfon Duangkamsee ◽  
Bongkot Burapakiat ◽  
Theerapat Buppodom ◽  
Ukrit Rojanusorn ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Primary Care ◽  
Primary Prevention ◽  
University Hospital ◽  
Diabetic Patients ◽  
Type 2 Diabetic Patients ◽  
Primary Care Unit ◽  
Type 2 Diabetic ◽  
Prevention Of Cardiovascular Disease

Objectives: This study aimed to assess the prevalence of under-prescription among elderly type 2 diabetic patients in the primary care unit of a university hospital in southern Thailand and identify the associated factors.Material and Methods: A 1-year retrospective medical record review was conducted in elderly type 2 diabetic patients treated continuously in the primary care unit. Under-prescription was the primary outcome assessed from criteria developed from the START criteria (2015), Thailand’s clinical practice guideline for diabetes (2014), and for hypertension (2015).Results: This study included 458 medical records that fit our inclusion criteria. The median age was 69.1 years old and more than 80% of them had a comorbidity of dyslipidemia or hypertension. The prevalence of under-prescription in elderly type 2 diabetic patients was 84.5%. The most commonly omitted medication was aspirin for primary prevention of cardiovascular disease. An increased number of medications received and having cardiovascular disease was associated with a lower risk of under-prescription.Conclusion: The prevalence of the omission of beneficial medications in elderly type 2 diabetic patients in the primary care unit of a university hospital was high, especially under-prescription of aspirin for primary prevention of cardiovascular disease.

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