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 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.

Adjuvant Supplementation with L-Carnitine in Diabetic Population and its effects on Lipid Parameters

2021 ◽  
Vol 15 (8) ◽  
pp. 2017-2019
Author(s):  
Rao Salman Aziz ◽  
Usman Saeed ◽  
Nasim Aslam Ghumman ◽  
Muhammad Arshad ◽  
Asif Sohail ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Triglyceride Level ◽  
Clinical Care ◽  
Diabetic Patients ◽  
Healthy Population ◽  
Patients With Diabetes ◽  
Diabetic Population ◽  
Large Discount ◽  
The Impact ◽  
Lipid Parameters

Background: Diabetes is a complicated disease requires continuous clinical care, to govern blood sugar. Aim: To decides the impact of management of L carentin to diabetics at the lipid profile. Methods: This study turned into performed on 120 diabetic Patients had been decided on from endocrinology and diabetes, inside decided on standards. The Patients distributed into three Strata (1st Strata of healthy population and two Strata of patients with diabetes who were on metformin and glibenclamide, one Strata took a L carnitine in a dose of 1000 mg TDS and a Strata dealing with a placebo for a period of ninety days). Results: It is observed those who are on Lcarnitine, confirmed a large discount (p <0.05) with inside the triglyceride level, at the same time as no large adjustments had been located withinside the level of cholesterol and HDL and LDL. Conclusion: These study outcomes that management of L carentin improved profile of lipid in type-2diabetic Patients. Keyword: Dyslipidemia, Diabetes mellitus (DM), l-carnitine (LC).

CORRELATION BETWEEN SERUM MAGNESIUM AND LIPID PROFILE IN DIABETIC PATIENTS AND ITS ASSOCIATION WITH COMPLICATIONS.

2021 ◽  
pp. 14-18
Author(s):  
Pankaj Kumar Singh ◽  
Dhaval Kumar Bhadja ◽  
Mohit Bhatnagar ◽  
Mandeep Joshi ◽  
Shreya Verma
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Total Cholesterol ◽  
Diabetic Complications ◽  
Serum Magnesium ◽  
Diabetic Patients ◽  
Diabetic Population ◽  
Inpatient Department

Background and aim: The present study was conducted to evaluate serum Magnesium and lipid prole in diabetic patients and to nd out any correlation between serum magnesium and lipid prole in diabetic patients and its association with complications. Material and Methods: In the present study, 70 diagnosed Type 2 diabetes mellitus patients aged >30 years attending Diabetic Outpatient and Inpatient Department at Vivekananda Polyclinic giving their consent for inclusion were considered to be included in the study as Cases. Results:In present the study, mean S. magnesium levels of patients with diabetic complications were found to be signicantly lower (1.09±0.22 mg/dl) as compared to that of patients in whom no diabetic complications were seen (2.19±0.71) and this difference was signicant statistically.Conclusions: In the diabetic population correlations of serum magnesium and Total cholesterol, triglyceride, LDL and VLDL were Mild while HDL was of moderate level. Among controls correlations of Serum Magnesium with Total cholesterol, triglyceride, LDL, VLDL, and HDL were found to be weak and not found to be statistically signicant.

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

scholarly journals THE PROBLEM OF STATINS DIABETOGENIC POTENTIAL AND WAYS OF ITS SOLUTION (review)

2020 ◽  
Vol 74 (4) ◽  
pp. 147-154
Author(s):  
V. Buheruk ◽  
O. Voloshyna ◽  
O. Dukova ◽  
I. Lysij ◽  
E. Naydionova ◽  
...  
Keyword(s):  
Insulin Resistance ◽  
Clinical Trials ◽  
High Risk ◽  
Secondary Prevention ◽  
Statin Therapy ◽  
High Intensity ◽  
Randomized Clinical Trials ◽  
Cardiovascular Complications ◽  
Diabetic Patients ◽  
Primary And Secondary Prevention

Aim. Current review summarized and analysed existing evidence of diabetogenic effect of statins and potential ways to overcome this problem in non-diabetic and diabetic patients. Materials and methods. Systematic literature review included results of experimental and clinical studies, multi-center placebo-controlled trials (JUPITER, ТNТ, IDEAL, SPARCL, METSIM, WOSCOPS, ALLHAT-LLT, PROSPER, etc.), systematic reviews and meta-analyses, current guidelines on statin prescription in high-risk patients and non-diabetic patients.Results of the reviewed clinical trials assessing the effects of long-term statin administration, data from randomized clinical trials and genetic studies provide convincing evidence of small, yet significant increase in absolute risk of new-onset diabetes (1 case of diabetes per 1000 patients per 1 year of treatment), concurrently preventing 5 new cases of cardiovascular disease. Diabetogenic properties are identified as probable class-effect of statins, with risk increased in high-intensity statin therapy. Diabetogenic effects are mediated through reduction in pancreatic β-cell function and impaired insulin resistance. Based on current international guidelines (ESC 2019, ADA 2020), the article highlights that despite modest diabetogenic potential, statins are recommended for primary and secondary prevention in patients with high risk of cardiovascular complications, including patients with diabetes. Conclusions. Statin therapy, especially high-intensity dosing can promote new cases of diabetes, particularly in patients with pre-existing metabolic syndrome and insulin resistance. Despite moderate diabetogenic effect statins are routinely recommended (ESC 2019, ADA 2020) for primary and secondary prevention in patients at high risk of cardiovascular complications, including diabetic patients. Statin therapy should be tailored to patient’s age, sex, concomitant diseases, parameters of lipid and glucose metabolism and presence of additional diabetogenic risk factors. Patients require lifestyle modification to reduce the risk of diabetes.

Optimal strategy for antiplatelet therapy after coronary drug-eluting stent implantation in high-risk "TWILIGHT-like" patients with diabetes mellitus

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
HY Wang ◽  
ZX Cai ◽  
D Yin ◽  
WH Song ◽  
L Feng ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Myocardial Infarction ◽  
High Risk ◽  
Antiplatelet Therapy ◽  
Bleeding Complications ◽  
Diabetic Patients ◽  
Medical Sciences ◽  
Cerebrovascular Events ◽  
Patients With Diabetes ◽  
Effectiveness Endpoint

Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): Chinese College of Cardiovascular Physicians, CS Optimizing Antithrombotic Research Fund (Grant No. BJUHFCSOARF201801-01), the National Key Research and Development Program of China (Grant No. 2018YFC1315602), the Beijing Municipal Health Commission (Grant No. 2020-1-4032), the Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences (Grant No. 2016-I2M-1-009), and the National Natural Science Foundation of China (Grant No. 81870277). Background Patients with diabetes mellitus (DM) are known to be at high-risk for both ischemic and bleeding complications post-percutaneous coronary intervention (PCI). The ischemic benefit versus bleeding risk associated with extended dual antiplatelet therapy (DAPT) in high-risk "TWILIGHT-like" patients with diabetes mellitus after PCI has not been established. Methods All consecutive high-risk patients fulfilling the "TWILIGHT-like" criteria undergoing PCI from January 2013 through December 2013 were identified from prospective Fuwai PCI Registry. High-risk "TWILIGHT-like" patients were defined by at least 1 clinical and 1 angiographic feature based on TWILIGHT trial selection criteria. The present analysis evaluated 3425 diabetics patients with concomitant high-risk angiographic features who were event-free at 1 year after PCI. Median follow-up was 2.4 years. The primary effectiveness endpoint was a composite of death, myocardial infarction, or stroke (termed major adverse cardiac and cerebrovascular events) and primary safety endpoint was clinically relevant bleeding according to Bleeding Academic Research Consortium type 2, 3, or 5. Results On inverse probability of treatment weighting (IPTW) analysis, prolonged-term (&gt;1-year) DAPT with aspirin and clopidogrel decreased the risk of primary effectiveness endpoint compared with shorter (≤1-year) DAPT (1.8% vs. 4.3%; hazard ratio [HR]IPTW: 0.381; 95% confidence interval [CI]: 0.252-0.576; P &lt; 0.001) and reduced cardiovascular death (0.1% vs. 1.8%; HRIPTW: 0.056 [0.016-0.193]). Prolonged DAPT was also associated with a reduced risk of definite/probable stent thrombosis (0.2% vs. 0.7%; HRIPTW: 0.258 [0.083-0.802]), and non-significantly lower rate of myocardial infarction (0.5% vs. 0.8%; HRIPTW: 0.676 [0.275-1.661]). There was no significant difference between groups in clinically relevant bleeding (1.1% vs. 1.1%; HRIPTW: 1.078 [0.519-2.241]; P = 0.840). Similar results were observed in multivariable Cox proportional hazards regression model. Conclusion Among high-risk PCI patients with diabetes mellitus without an adverse event through 1 year, extending DAPT &gt; 1-year significantly reduced the risk of major adverse cardiac and cerebrovascular events without an increase in clinically relevant bleeding, suggesting that such high-risk diabetic patients may be good candidates for long-term DAPT. Abstract Figure.

Pharmacological Management of Cardiac Disease in Patients with Type 2 Diabetes: Insights into Clinical Practice

2020 ◽  
Vol 18 (2) ◽  
pp. 125-138 ◽  
Author(s):  
Dimitrios Patoulias ◽  
Konstantinos Stavropoulos ◽  
Konstantinos Imprialos ◽  
Vasilios Athyros ◽  
Michael Doumas ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Secondary Prevention ◽  
New Drugs ◽  
Therapeutic Interventions ◽  
Diabetic Patients ◽  
Primary And Secondary Prevention ◽  
Pcsk9 Inhibitors ◽  
Pharmacological Management ◽  
Major Health Problem

Background: Type 2 Diabetes Mellitus (T2DM) has emerged as a growing pandemic. Cardiovascular disease (CVD) constitutes another major health problem, with coronary heart disease being the leading cause of cardiovascular death. Patients with T2DM require a multilevel therapeutic approach, both for primary and secondary prevention of CVD. Objective: To present and summarize the most recent, highest level evidence retrieved from literature, relevant to the pharmaceutical management of CVD in T2DM. Method: We conducted a comprehensive search of the literature on MEDLINE from its inception till today, primarily for relevant systematic reviews, meta-analyses and randomized controlled trials. Results: There is a trend towards more intensified therapeutic interventions in T2DM, concerning glycemic, lipid and blood pressure control. New drugs, such as sodium-glucose co-transporter 2 (SGLT-2) inhibitors, glucagon-like peptide-1 receptor agonists (GLP-1RAs) and proprotein convertase subtilisin/ kexin type 9 (PCSK9) inhibitors might evolve as key players in the management of diabetes and its complications within the next years. Classic drugs, such as those targeting the renin-angiotensinaldosterone system, statins and aspirin remain first-line treatment options, both for primary and secondary prevention of CVD. Lifestyle interventions should always be integrated into a complete therapeutic strategy in diabetic patients. Novel drugs, such as finerenone and LCZ696 have provided significant results in cardiovascular outcome studies; however, their role in T2DM has to be further elucidated. Conclusion: Pharmaceutical approach of CVD in T2DM is multilevel and complex. Drug classes featuring pleiotropic effects may boost our armamentarium in the fight against CVD.

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