Abstract
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.
Highlights
Diabetes mellitus (DM) is associated with macrovascular and microvascular complications [1, 2].Platelets have a “key role” in atherogenesis and its thrombotic complications in subjects with DM [3], and the concomitant presence of multiple “classical” cardiovascular risk factors in diabetic subjects contributes to enhanced atherothrombotic risk.Platelets from subjects with DM, from those with type 2 diabetes, exhibit increased reactivity
The Japanese Primary Prevention of Atherosclerosis with Aspirin for Diabetes (JPAD) trial was the first prospective trial to evaluate the use of aspirin (81 or 100 mg) in the primary prevention of ischemic events in diabetic type 2 patients (n = 2, 539), aged 30–85 years, in Japan [15]
The Prevention of Progression of Arterial Disease and Diabetes (POPADAD) randomized trial failed to show any benefit of aspirin (100 mg) or antioxidant substances in primary prevention of vascular events in diabetic patients (n = 1, 276) aged >40 years with an ankle-brachial index ≤0.99, but no symptomatic CV disease
Summary
Diabetes mellitus (DM) is associated with macrovascular and microvascular complications (coronary artery disease, ischemic stroke, peripheral arterial disease, nephropathy, and retinopathy) [1, 2]. MPV is considered a marker of platelet function and activation: larger platelets are more reactive and aggregable. It has been shown that MPV is significantly higher in diabetic populations [5] It is increased in hypercholesterolemia, metabolic syndrome, acute myocardial infarction, acute ischemic stroke, preeclampsia, and renal artery stenosis [4]. Available antiplatelet agents, such as cyclooxygenase-1 (COX-1) inhibitors (aspirin), ADP P2Y12 receptor antagonists, and GP IIb/IIIa receptor inhibitors, are effective and save in the treatment and prevention of thrombotic events, these drugs interfere with the platelet activation process, including adhesion, release, and aggregation. The role of novel and more potent antiplatelet strategies, currently under clinical development, seems attractive in diabetic patients
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