No effect of lipid lowering on platelet activity in patients with coronary artery disease and type 2 diabetes or impaired glucose tolerance

SummaryIn addition to lowering cholesterol, statins may reduce platelet activity and exert beneficial non-lipid (pleiotropic) effects. We evaluated the effects of two different simvastatin based treatment regimens on platelet reactivity in patients with dysglycemia and coronary artery disease (CAD). Thirty-two patients with type 2 diabetes or impaired glucose tolerance and stable CAD received six weeks of double-blind treatment with simvastatin 80 mg daily (S80; n=16) or ezetimibe 10 mg and simvastatin 10 mg daily (E10/S10; n=16). Total and low-density lipoprotein (LDL) cholesterol, and high sensitivity C-reactive protein (CRP) decreased similarly in the two groups. LDL (mM) decreased from 3.2 ± 0.6 to 1.7 ± 0.7 with E10/S10 and from 3.0 ± 1.0 to 1.4 ± 0.5 with S80 treatment. Platelet function was evaluated by whole blood flow cytometry and turbidimetric aggregometry with agonist stimulation ex vivo before and after treatment. Neither treatment affected basal or adenosine diphosphate (ADP)- or thrombin-induced platelet P-selectin expression, or fibrinogen binding, or platelet-leukocyte aggregation. Similarly, neither treatment affected ADP-induced platelet aggregation. In conclusion, lipid lowering treatment with high dose simvastatin or low dose simvastatin plus ezetimibe did not exert any substantial inhibitory effects on the basal or agonist-stimulated activity of circulating platelets in patients with stable CAD and type 2 diabetes or impaired glucose tolerance.

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Prevalence, prescriptions, outcomes and costs of type 2 diabetes patients with or without prior coronary artery disease or stroke: a longitudinal 5-year claims-data analysis of over 7 million inhabitants

Therapeutic Advances in Chronic Disease ◽

10.1177/20406223211026390 ◽

2021 ◽

Vol 12 ◽

pp. 204062232110263

Author(s):

Aldo Pietro Maggioni ◽

Letizia Dondi ◽

Felicita Andreotti ◽

Giulia Ronconi ◽

Silvia Calabria ◽

...

Keyword(s):

Type 2 Diabetes ◽

Coronary Artery Disease ◽

Coronary Artery ◽

Cardiovascular Events ◽

Hospital Admissions ◽

Lipid Lowering ◽

Lipid Lowering Therapy ◽

Recommended Treatment ◽

Artery Disease

Aims: To analyze the prevalence, comorbidities, outcomes and costs of type 2 diabetes mellitus (T2DM) patients with and without coronary artery disease (CAD) or stroke in a population of over 7 million inhabitants. Methods: T2DM patients were identified in 2015 (accrual period) from the Ricerca e Salute (ReS) database linking administrative records to demographics. Based on 2013–2015 information, four cohorts were considered: #1 with CAD and/or stroke; #2 without CAD and/or stroke; #3 with chronic CAD but no myocardial infarction or stroke; #4 with chronic CAD undergoing percutaneous coronary interventions (PCI). Hospitalizations, drugs and other outpatient care were assessed from 2015 to 2017. Results: The prevalence of T2DM was 6% (441,085/7,365,954). CAD and/or stroke in the previous 3 years affected 7.5% of T2DM patients (33,153); this cohort was generally older, of male sex, with more comorbidities, prescriptions, and hospital admissions (50.5% versus 13.4% during the first follow-up year) compared to cohort #2. Yearly costs were over three-fold for cohort #1 versus #2, main drivers being hospitalizations in the former and drugs in the latter. Two-year cardiovascular events were recorded significantly more commonly in cohort #4 compared to the other cohorts. Guideline-recommended lipid-lowering therapy was <80% in all but cohort #4. Conclusions: The present analysis points to three areas of potential improvement in T2DM management: (a) guideline-recommended treatment patterns of T2DM patients; (b) three-fold recurrences and costs in T2DM patients with, compared to those without, prior cardiovascular events; (c) high event rates associated with chronic CAD and PCI, warranting specific studies aimed at improved prevention.

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Analysis of the endocrine status of patients with coronary artery disease in cardiac surgery

Ukrainian Journal of Cardiology ◽

10.31928/1608-635x-2021.1.2633 ◽

2021 ◽

Vol 28 (1) ◽

pp. 26-33

Author(s):

O. K. Gogayeva ◽

A. V. Rudenko ◽

V. V. Lazoryshynets ◽

L. S. Dzakhoieva

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

High Risk ◽

Glucose Tolerance ◽

Impaired Glucose Tolerance ◽

Type 2 Dm ◽

Endocrine Status ◽

Risk Patients ◽

Artery Disease

The aim – to analyze the endocrine status of high-risk patients with coronary artery disease in cardiac surgery.Materials and methods. Retrospective analysis of data from random 354 high-risk patients who were operated on and discharged from M.M. Amosov National Institute of Cardiovascular Surgery of NAMS of Ukraine in the period from 2009 to 2019. The mean age of patients was 61.9±9.7 years. All patients underwent ECG, ECHO, coronary angiography and surgical myocardial revascularization with correction of concomitant cardiac pathology, if necessary. In the perioperative period all patients underwent general clinical and biochemical blood tests. Stratifying the risk according to the EuroSCORE II scale, patients belonged to the high risk group and had > 5 % probability of mortality.Results and discussion. All patients had hemodynamically significant stenosis of the coronary arteries that required surgical revascularization of the myocardium. The analysis showed that 287 (81.07 %) patients were overweight, 281 (79.3 %) – had metabolic syndrome, 90 (25.4 %) – type 2 diabetes mellitus (type 2 DM), 161 (45.45 %) – impaired glucose tolerance. Thyroid disease was diagnosed in 37 (10.4 %) patients, 11 (3.1 %) patients had hypothyroidism. In the postoperative period, paroxysms of atrial fibrillation occurred in 83 (23.4 %) patients, of whom 70 (84.3 %) had type 2 DM and impaired glucose tolerance. Deep sternal infection occurred in 4 (4.4 %) patients with type 2 DM, for 3 (3.3 %) of them sternoplasty performed. Neurological complications – stroke and transient ischemic attack had 10 (2.8 %) patients among which 9 (90 %) had glucose metabolism disturbance. Acute renal failure occurred in 10 (2.8 %) patients, of whom 8 (80 %) had type 2 DM and pre-DM.Conclusions. Despite the high predicted mortality on the EuroSCORE II scale – 8.82 %, the operative mortality in the study group was 0 %, which indicates a coordinated highly skilled Heart-team work, timely verification of comorbid conditions and the involvement of related specialists.

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