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Amalia M, Puteri MU, Saputri FC, Sauriasari R, Widyantoro B. Platelet Glycoprotein-Ib (GPIb) May Serve as a Bridge between Type 2 Diabetes Mellitus (T2DM) and Atherosclerosis, Making It a Potential Target for Antiplatelet Agents in T2DM Patients. Life (Basel) 2023; 13:1473. [PMID: 37511848 PMCID: PMC10381765 DOI: 10.3390/life13071473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 06/23/2023] [Accepted: 06/26/2023] [Indexed: 07/30/2023] Open
Abstract
Type 2 diabetes mellitus (T2DM) is a persistent metabolic condition that contributes to the development of cardiovascular diseases. Numerous studies have provided evidence that individuals with T2DM are at a greater risk of developing cardiovascular diseases, typically two to four times more likely than those without T2DM, mainly due to an increased risk of atherosclerosis. The rupture of an atherosclerotic plaque leading to pathological thrombosis is commonly recognized as a significant factor in advancing cardiovascular diseases caused by TD2M, with platelets inducing the impact of plaque rupture in established atherosclerosis and predisposing to the primary expansion of atherosclerosis. Studies suggest that individuals with T2DM have platelets that display higher baseline activation and reactivity than those without the condition. The expression enhancement of several platelet receptors is known to regulate platelet activation signaling, including platelet glycoprotein-Ib (GPIb). Furthermore, the high expression of platelet GP1b has been reported to increase the risk of platelet adhesion, platelet-leucocyte interaction, and thrombo-inflammatory pathology. However, the study exploring the role of GP1b in promoting platelet activation-induced cardiovascular diseases in T2DM patients is still limited. Therefore, we summarize the important findings regarding pathophysiological continuity between T2DM, platelet GPIb, and atherosclerosis and highlight the potential therapy targeting GPIb as a novel antiplatelet agent for preventing further cardiovascular incidents in TD2M patients.
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Affiliation(s)
- Muttia Amalia
- Doctoral Program, Faculty of Pharmacy, Universitas Indonesia, Kampus UI Depok, Depok 16424, Indonesia
| | - Meidi Utami Puteri
- Laboratory of Pharmacology-Toxicology, Faculty of Pharmacy, Universitas Indonesia, Kampus UI Depok, Depok 16424, Indonesia
| | - Fadlina Chany Saputri
- Laboratory of Pharmacology-Toxicology, Faculty of Pharmacy, Universitas Indonesia, Kampus UI Depok, Depok 16424, Indonesia
| | - Rani Sauriasari
- Faculty of Pharmacy, Universitas Indonesia, Kampus UI Depok, Depok 16424, Indonesia
| | - Bambang Widyantoro
- National Cardiovascular Center Harapan Kita, Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta 11420, Indonesia
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2
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Camm AJ, Sabbour H, Schnell O, Summaria F, Verma A. Managing thrombotic risk in patients with diabetes. Cardiovasc Diabetol 2022; 21:160. [PMID: 35996159 PMCID: PMC9396895 DOI: 10.1186/s12933-022-01581-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 06/25/2022] [Indexed: 12/24/2022] Open
Abstract
It is well known that diabetes is a prominent risk factor for cardiovascular (CV) events. The level of CV risk depends on the type and duration of diabetes, age and additional co-morbidities. Diabetes is an independent risk factor for atrial fibrillation (AF) and is frequently observed in patients with AF, which further increases their risk of stroke associated with this cardiac arrhythmia. Nearly one third of patients with diabetes globally have CV disease (CVD). Additionally, co-morbid AF and coronary artery disease are more frequently observed in patients with diabetes than the general population, further increasing the already high CV risk of these patients. To protect against thromboembolic events in patients with diabetes and AF or established CVD, guidelines recommend optimal CV risk factor control, including oral anticoagulation treatment. However, patients with diabetes exist in a prothrombotic and inflammatory state. Greater clinical benefit may therefore be seen with the use of stronger antithrombotic agents or innovative drug combinations in high-risk patients with diabetes, such as those who have concomitant AF or established CVD. In this review, we discuss CV risk management strategies in patients with diabetes and concomitant vascular disease, stroke prevention regimens in patients with diabetes and AF and how worsening renal function in these patients may complicate these approaches. Accumulating evidence from clinical trials and real-world evidence show a benefit to the administration of non-vitamin K antagonist oral anticoagulants for stroke prevention in patients with diabetes and AF.
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Affiliation(s)
- A John Camm
- Division of Cardiac and Vascular Sciences, Molecular and Clinical Sciences Research Institute, St George's, University of London, London, Cranmer Terrace, SW17 0RE, UK.
| | - Hani Sabbour
- Heart and Vascular Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates.,Warren Alpert School of Medicine, Brown University, Rhode Island, USA
| | - Oliver Schnell
- Forschergruppe Diabetes e.V., Neuherberg, Munich, Germany
| | | | - Atul Verma
- Southlake Regional Health Centre, Newmarket, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada
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3
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The Role of Platelets in Diabetic Kidney Disease. Int J Mol Sci 2022; 23:ijms23158270. [PMID: 35955405 PMCID: PMC9368651 DOI: 10.3390/ijms23158270] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 07/22/2022] [Accepted: 07/22/2022] [Indexed: 01/10/2023] Open
Abstract
Diabetic kidney disease (DKD) is among the most common microvascular complications in patients with diabetes, and it currently accounts for the majority of end-stage kidney disease cases worldwide. The pathogenesis of DKD is complex and multifactorial, including systemic and intra-renal inflammatory and coagulation processes. Activated platelets play a pivotal role in inflammation, coagulation, and fibrosis. Mounting evidence shows that platelets play a role in the pathogenesis and progression of DKD. The potentially beneficial effects of antiplatelet agents in preventing progression of DKD has been studied in animal models and clinical trials. This review summarizes the current knowledge on the role of platelets in DKD, including the potential therapeutic effects of antiplatelet therapies.
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Berger M, Baaten CCFMJ, Noels H, Marx N, Schütt K. [Heart and diabetes : Platelet function and antiplatelet therapy in chronic kidney disease]. Herz 2022; 47:426-433. [PMID: 35861809 DOI: 10.1007/s00059-022-05129-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2022] [Indexed: 11/04/2022]
Abstract
Patients with chronic kidney disease (CKD) have an increased risk of thrombosis and approximately 50% of patients with advanced CKD die because of a cardiovascular disease. In addition to an increased risk of thrombosis, patients with CKD and particularly with advanced CKD, have an increased risk of hemorrhage, which increases parallel to the decline of kidney function. Due to this parallel existence of the prohemorrhagic and prothrombotic phenotype, antiplatelet treatment is difficult in the daily routine and data show that CKD patients with acute coronary syndrome (ACS) are less likely to receive guideline-conform treatment. The underlying mechanisms are currently insufficiently understood and both platelet-dependent mechanisms and also platelet-independent mechanisms are under discussion. Accordingly, there is currently no specific treatment or treatment strategy for patients with CKD. In addition, CKD patients are underrepresented in registration studies on antiplatelet treatment and there are no data from randomized trials for patients with advanced CKD (CKD ≥ 4). Current guideline recommendations are therefore based on subgroup analyses and observational studies. In addition, questions on the duration of treatment, on risk scores for estimation of the risk of hemorrhage and on potential benefits of escalation and de-escalation strategies remain largely unanswered and should therefore be the focus of future studies.
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Affiliation(s)
- Martin Berger
- Department of Internal Medicine I, RWTH Aachen University Hospital, Aachen, Deutschland.
| | - Constance C F M J Baaten
- Institut für Molekulare Herz-Kreislauf-Forschung (IMCAR), RWTH Aachen University, Aachen, Deutschland.,Department of Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, Niederlande
| | - Heidi Noels
- Institut für Molekulare Herz-Kreislauf-Forschung (IMCAR), RWTH Aachen University, Aachen, Deutschland.,Department of Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, Niederlande
| | - Nikolaus Marx
- Department of Internal Medicine I, RWTH Aachen University Hospital, Aachen, Deutschland
| | - Katharina Schütt
- Department of Internal Medicine I, RWTH Aachen University Hospital, Aachen, Deutschland
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5
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Ma CX, Ma XN, Guan CH, Li YD, Mauricio D, Fu SB. Cardiovascular disease in type 2 diabetes mellitus: progress toward personalized management. Cardiovasc Diabetol 2022; 21:74. [PMID: 35568946 PMCID: PMC9107726 DOI: 10.1186/s12933-022-01516-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 04/28/2022] [Indexed: 01/10/2023] Open
Abstract
Cardiovascular diseases (CVDs) are the main cause of death among patients with type 2 diabetes mellitus (T2DM), particularly in low- and middle-income countries. To effectively prevent the development of CVDs in T2DM, considerable effort has been made to explore novel preventive approaches, individualized glycemic control and cardiovascular risk management (strict blood pressure and lipid control), together with recently developed glucose-lowering agents and lipid-lowering drugs. This review mainly addresses the important issues affecting the choice of antidiabetic agents and lipid, blood pressure and antiplatelet treatments considering the cardiovascular status of the patient. Finally, we also discuss the changes in therapy principles underlying CVDs in T2DM.
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Affiliation(s)
- Cheng-Xu Ma
- Department of Endocrinology, The First Hospital of Lanzhou University, No. 1 West Donggang Road, Lanzhou, Gansu, 730000, People's Republic of China.,The First Clinical Medical College of Lanzhou University, Lanzhou, 730000, Gansu, China
| | - Xiao-Ni Ma
- Department of Endocrinology, The First Hospital of Lanzhou University, No. 1 West Donggang Road, Lanzhou, Gansu, 730000, People's Republic of China.,The First Clinical Medical College of Lanzhou University, Lanzhou, 730000, Gansu, China
| | - Cong-Hui Guan
- Department of Endocrinology, The First Hospital of Lanzhou University, No. 1 West Donggang Road, Lanzhou, Gansu, 730000, People's Republic of China.,The First Clinical Medical College of Lanzhou University, Lanzhou, 730000, Gansu, China
| | - Ying-Dong Li
- College of Integrated Traditional Chinese and Western Medicine, Gansu University of Chinese Medicine, Lanzhou, 730000, Gansu, China
| | - Dídac Mauricio
- Department of Endocrinology & Nutrition, CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, 08041, Barcelona, Spain.
| | - Song-Bo Fu
- Department of Endocrinology, The First Hospital of Lanzhou University, No. 1 West Donggang Road, Lanzhou, Gansu, 730000, People's Republic of China. .,The First Clinical Medical College of Lanzhou University, Lanzhou, 730000, Gansu, China.
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6
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Natale P, Palmer SC, Saglimbene VM, Ruospo M, Razavian M, Craig JC, Jardine MJ, Webster AC, Strippoli GF. Antiplatelet agents for chronic kidney disease. Cochrane Database Syst Rev 2022; 2:CD008834. [PMID: 35224730 PMCID: PMC8883339 DOI: 10.1002/14651858.cd008834.pub4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Antiplatelet agents are widely used to prevent cardiovascular events. The risks and benefits of antiplatelet agents may be different in people with chronic kidney disease (CKD) for whom occlusive atherosclerotic events are less prevalent, and bleeding hazards might be increased. This is an update of a review first published in 2013. OBJECTIVES To evaluate the benefits and harms of antiplatelet agents in people with any form of CKD, including those with CKD not receiving renal replacement therapy, patients receiving any form of dialysis, and kidney transplant recipients. SEARCH METHODS We searched the Cochrane Kidney and Transplant Register of Studies up to 13 July 2021 through contact with the Information Specialist using search terms relevant to this review. Studies in the Register are identified through searches of CENTRAL, MEDLINE, and EMBASE, conference proceedings, the International Clinical Trials Register (ICTRP) Search Portal and ClinicalTrials.gov. SELECTION CRITERIA We selected randomised controlled trials of any antiplatelet agents versus placebo or no treatment, or direct head-to-head antiplatelet agent studies in people with CKD. Studies were included if they enrolled participants with CKD, or included people in broader at-risk populations in which data for subgroups with CKD could be disaggregated. DATA COLLECTION AND ANALYSIS Four authors independently extracted data from primary study reports and any available supplementary information for study population, interventions, outcomes, and risks of bias. Risk ratios (RR) and 95% confidence intervals (CI) were calculated from numbers of events and numbers of participants at risk which were extracted from each included study. The reported RRs were extracted where crude event rates were not provided. Data were pooled using the random-effects model. Confidence in the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. MAIN RESULTS We included 113 studies, enrolling 51,959 participants; 90 studies (40,597 CKD participants) compared an antiplatelet agent with placebo or no treatment, and 29 studies (11,805 CKD participants) directly compared one antiplatelet agent with another. Fifty-six new studies were added to this 2021 update. Seven studies originally excluded from the 2013 review were included, although they had a follow-up lower than two months. Random sequence generation and allocation concealment were at low risk of bias in 16 and 22 studies, respectively. Sixty-four studies reported low-risk methods for blinding of participants and investigators; outcome assessment was blinded in 41 studies. Forty-one studies were at low risk of attrition bias, 50 studies were at low risk of selective reporting bias, and 57 studies were at low risk of other potential sources of bias. Compared to placebo or no treatment, antiplatelet agents probably reduces myocardial infarction (18 studies, 15,289 participants: RR 0.88, 95% CI 0.79 to 0.99, I² = 0%; moderate certainty). Antiplatelet agents has uncertain effects on fatal or nonfatal stroke (12 studies, 10.382 participants: RR 1.01, 95% CI 0.64 to 1.59, I² = 37%; very low certainty) and may have little or no effect on death from any cause (35 studies, 18,241 participants: RR 0.94, 95 % CI 0.84 to 1.06, I² = 14%; low certainty). Antiplatelet therapy probably increases major bleeding in people with CKD and those treated with haemodialysis (HD) (29 studies, 16,194 participants: RR 1.35, 95% CI 1.10 to 1.65, I² = 12%; moderate certainty). In addition, antiplatelet therapy may increase minor bleeding in people with CKD and those treated with HD (21 studies, 13,218 participants: RR 1.55, 95% CI 1.27 to 1.90, I² = 58%; low certainty). Antiplatelet treatment may reduce early dialysis vascular access thrombosis (8 studies, 1525 participants) RR 0.52, 95% CI 0.38 to 0.70; low certainty). Antiplatelet agents may reduce doubling of serum creatinine in CKD (3 studies, 217 participants: RR 0.39, 95% CI 0.17 to 0.86, I² = 8%; low certainty). The treatment effects of antiplatelet agents on stroke, cardiovascular death, kidney failure, kidney transplant graft loss, transplant rejection, creatinine clearance, proteinuria, dialysis access failure, loss of primary unassisted patency, failure to attain suitability for dialysis, need of intervention and cardiovascular hospitalisation were uncertain. Limited data were available for direct head-to-head comparisons of antiplatelet drugs, including prasugrel, ticagrelor, different doses of clopidogrel, abciximab, defibrotide, sarpogrelate and beraprost. AUTHORS' CONCLUSIONS Antiplatelet agents probably reduced myocardial infarction and increased major bleeding, but do not appear to reduce all-cause and cardiovascular death among people with CKD and those treated with dialysis. The treatment effects of antiplatelet agents compared with each other are uncertain.
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Affiliation(s)
- Patrizia Natale
- Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
- Nephrology, Dialysis and Transplantation Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Suetonia C Palmer
- Department of Medicine, University of Otago Christchurch, Christchurch, New Zealand
| | - Valeria M Saglimbene
- Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Marinella Ruospo
- Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Mona Razavian
- Renal and Metabolic Division, The George Institute for Global Health, Newtown, Australia
| | - Jonathan C Craig
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
- Cochrane Kidney and Transplant, Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Australia
| | | | - Angela C Webster
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
- Centre for Transplant and Renal Research, Westmead Millennium Institute, The University of Sydney at Westmead, Westmead, Australia
| | - Giovanni Fm Strippoli
- Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
- Cochrane Kidney and Transplant, Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Australia
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7
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Mangiacapra F, Paolucci L, Viscusi MM, Mangiacapra R, Ferraro PM, Nusca A, Melfi R, De Luca L, Gabrielli D, Ussia GP, Grigioni F. Prevalence and clinical impact of high platelet reactivity in patients with chronic kidney disease treated with percutaneous coronary intervention: An updated systematic review and meta‐analysis. Catheter Cardiovasc Interv 2022; 99:1086-1094. [DOI: 10.1002/ccd.30071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 12/17/2021] [Accepted: 12/25/2021] [Indexed: 11/06/2022]
Affiliation(s)
- Fabio Mangiacapra
- Unit of Cardiovascular Science, Department of Medicine Campus Bio‐Medico University Rome Italy
| | - Luca Paolucci
- Unit of Cardiovascular Science, Department of Medicine Campus Bio‐Medico University Rome Italy
| | - Michele M. Viscusi
- Unit of Cardiovascular Science, Department of Medicine Campus Bio‐Medico University Rome Italy
| | - Roberto Mangiacapra
- U.O.C. Nefrologia Fondazione Policlinico Universitario A. Gemelli IRCCS Rome Italy
- Università Cattolica del Sacro Cuore Rome Italy
| | - Pietro M. Ferraro
- U.O.C. Nefrologia Fondazione Policlinico Universitario A. Gemelli IRCCS Rome Italy
- Università Cattolica del Sacro Cuore Rome Italy
| | - Annunziata Nusca
- Unit of Cardiovascular Science, Department of Medicine Campus Bio‐Medico University Rome Italy
| | - Rosetta Melfi
- Unit of Cardiovascular Science, Department of Medicine Campus Bio‐Medico University Rome Italy
| | | | | | - Gian P. Ussia
- Unit of Cardiovascular Science, Department of Medicine Campus Bio‐Medico University Rome Italy
| | - Francesco Grigioni
- Unit of Cardiovascular Science, Department of Medicine Campus Bio‐Medico University Rome Italy
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Outcomes after ticagrelor versus clopidogrel treatment in end-stage renal disease patients with acute myocardial infarction: a nationwide cohort study. Sci Rep 2021; 11:20826. [PMID: 34675293 PMCID: PMC8531372 DOI: 10.1038/s41598-021-00360-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 10/08/2021] [Indexed: 11/15/2022] Open
Abstract
Clinical outcomes are unknown after ticagrelor treatment in patients with end-stage renal disease (ESRD) who are diagnosed with acute myocardial infarction (AMI). ESRD patients who were on hemodialysis and received dual antiplatelet therapy (DAPT) for AMI between July 2013 and December 2016 were identified in Taiwan's National Health Insurance Research Database. Using stabilized inverse probability of treatment weighting, patients receiving aspirin plus ticagrelor (n = 530) were compared with those receiving aspirin plus clopidogrel (n = 2462) for the primary efficacy endpoint, a composite of all-cause death, nonfatal myocardial infarction, or nonfatal stroke, and bleeding, defined according to the Bleeding Academic Research Consortium. Study outcomes were compared between the two groups using Cox proportional hazards model or competing risk model for the hazard ratio or subdistribution hazard ratio (SHR). During 9 months of follow-up, ticagrelor was comparable to clopidogrel with respect to the risks of primary efficacy endpoint [11.69 vs. 9.28/100 patient-months; SHR, 1.16; 95% confidence interval (CI) 0.97–1.4] and bleeding (5.55 vs. 4.36/100 patient-months; SHR 1.14; 95% CI 0.88–1.47). In conclusion, among hemodialysis patients receiving DAPT for AMI, ticagrelor was comparable to clopidogrel with regard to the composite efficacy endpoint and bleeding.
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Stefanini GG, Briguori C, Cao D, Baber U, Sartori S, Zhang Z, Dangas G, Angiolillo DJ, Mehta S, Cohen DJ, Collier T, Dudek D, Escaned J, Gibson CM, Gil R, Huber K, Kaul U, Kornowski R, Krucoff MW, Kunadian V, Moliterno DJ, Ohman EM, Oldroyd KG, Sardella G, Sharma SK, Shlofmitz R, Weisz G, Witzenbichler B, Pocock S, Mehran R. Ticagrelor monotherapy in patients with chronic kidney disease undergoing percutaneous coronary intervention: TWILIGHT-CKD. Eur Heart J 2021; 42:4683-4693. [PMID: 34423374 DOI: 10.1093/eurheartj/ehab533] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 06/07/2021] [Accepted: 07/26/2021] [Indexed: 12/20/2022] Open
Abstract
AIMS The aim of this study was to assess the impact of chronic kidney disease (CKD) on the safety and efficacy of ticagrelor monotherapy among patients undergoing percutaneous coronary intervention (PCI). METHODS AND RESULTS In this prespecified subanalysis of the TWILIGHT trial, we evaluated the treatment effects of ticagrelor with or without aspirin according to renal function. The trial enrolled patients undergoing drug-eluting stent implantation who fulfilled at least one clinical and one angiographic high-risk criterion. Chronic kidney disease, defined as an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2, was a clinical study entry criterion. Following a 3-month period of ticagrelor plus aspirin, event-free patients were randomly assigned to aspirin or placebo on top of ticagrelor for an additional 12 months. Of the 6835 patients randomized and with available eGFR at baseline, 1111 (16.3%) had CKD. Ticagrelor plus placebo reduced the primary endpoint of Bleeding Academic Research Consortium (BARC) type 2, 3, or 5 bleeding as compared with ticagrelor plus aspirin in both patients with [4.6% vs. 9.0%; hazard ratio (HR) 0.50, 95% confidence interval (CI) 0.31-0.80] and without (4.0% vs. 6.7%; HR 0.59, 95% CI 0.47-0.75; Pinteraction = 0.508) CKD, but the absolute risk reduction was greater in the former group. Rates of death, myocardial infarction, or stroke were not significantly different between the two randomized groups irrespective of the presence (7.9% vs. 5.7%; HR 1.40, 95% CI 0.88-2.22) or absence of (3.2% vs. 3.6%; HR 0.90, 95% CI 0.68-1.20; Pinteraction = 0.111) CKD. CONCLUSION Among CKD patients undergoing PCI, ticagrelor monotherapy reduced the risk of bleeding without a significant increase in ischaemic events as compared with ticagrelor plus aspirin.
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Affiliation(s)
- Giulio G Stefanini
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan 20090, Italy.,IRCCS Humanitas Research Hospital, Rozzano, Milan 20089, Italy
| | | | - Davide Cao
- The Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital, One Gustave L. Levy Place, Box 1030, New York, NY 10029-6574, USA
| | - Usman Baber
- The University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
| | | | | | - George Dangas
- The Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital, One Gustave L. Levy Place, Box 1030, New York, NY 10029-6574, USA
| | | | - Shamir Mehta
- Hamilton Health Sciences, Hamilton, ON L8N 3Z5, Canada
| | - David J Cohen
- Cardiovascular Research Foundation, New York, NY 10019, USA.,St. Francis Hospital, Roslyn, NY 11576, USA
| | - Timothy Collier
- London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - Dariusz Dudek
- Jagiellonian University Medical College, Krakow 31-008, Poland
| | - Javier Escaned
- Instituto de Investigacion Sanitaria del Hospital Clinico San Carlos and Complutense University, Madrid 28040, Spain
| | | | - Robert Gil
- Center of Postgraduate Medical Education, Central Clinical Hospital of the Ministry of Interior and Administration, Warsaw 02-507, Poland
| | | | - Upendra Kaul
- Batra Hospital and Medical Research Centre, New Delhi 110062, India
| | | | - Mitchell W Krucoff
- Duke University Medical Center-Duke Clinical Research Institute, Durham, NC 27710, USA
| | - Vijay Kunadian
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University and Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne NE7 7DN, UK
| | | | - E Magnus Ohman
- Duke University Medical Center-Duke Clinical Research Institute, Durham, NC 27710, USA
| | - Keith G Oldroyd
- The West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank G81 4DY, UK
| | | | - Samin K Sharma
- The Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital, One Gustave L. Levy Place, Box 1030, New York, NY 10029-6574, USA
| | | | - Giora Weisz
- New York Presbyterian Hospital, Columbia University Medical Center, New York, NY 10032, USA
| | | | - Stuart Pocock
- London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - Roxana Mehran
- The Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital, One Gustave L. Levy Place, Box 1030, New York, NY 10029-6574, USA
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10
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Kao CC, Wu MS, Chuang MT, Lin YC, Huang CY, Chang WC, Chen CW, Chang TH. Investigation of dual antiplatelet therapy after coronary stenting in patients with chronic kidney disease. PLoS One 2021; 16:e0255645. [PMID: 34347826 PMCID: PMC8336855 DOI: 10.1371/journal.pone.0255645] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 07/19/2021] [Indexed: 11/28/2022] Open
Abstract
Background Dual antiplatelet therapy (DAPT) is currently the standard treatment for the prevention of ischemic events after stent implantation. However, the optimal DAPT duration remains elusive for patients with chronic kidney disease (CKD). Therefore, we aimed to compare the effectiveness and safety between long-term and short-term DAPT after coronary stenting in patients with CKD. Methods This retrospective cohort study analyze data from the Taipei Medical University (TMU) Institutional and Clinical Database, which include anonymized electronic health data of 3 million patients that visited TMU Hospital, Wan Fang Hospital, and Shuang Ho Hospital. We enrolled patients with CKD after coronary stenting between 2008 and 2019. The patients were divided into the long-term (>6 months) and short-term DAPT group (≤ 6 months). The primary end point was major adverse cardiovascular events (MACE) from 6 months after the index date. The secondary outcomes were all-cause mortality and Thrombolysis in Myocardial Infarction (TIMI) bleeding. Results A total of 1899 patients were enrolled; of them, 1112 and 787 were assigned to the long-term and short-term DAPT groups, respectively. Long-term DAPT was associated with similar risk of MACE (HR: 1.05, 95% CI: 0.65–1.70, P = 0.83) compare with short-term DAPT. Different CKD risk did not modify the risk of MACE. There was also no significant difference in all-cause mortality (HR: 1.10, 95% CI: 0.75–1.61, P = 0.63) and TIMI bleeding (HR 1.19, 95% CI: 0.86–1.63, P = 0.30) between groups. Conclusions Among patients with CKD and coronary stenting, we found that long-term and short-term DAPT tied on the risk of MACE, all-cause mortality and TIMI bleeding.
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Affiliation(s)
- Chih-Chin Kao
- Division of Nephrology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Division of Nephrology, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan
- TMU Research Center of Urology and Kidney (TMU-RCUK), Taipei Medical University, Taipei, Taiwan
| | - Mai-Szu Wu
- Division of Nephrology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- TMU Research Center of Urology and Kidney (TMU-RCUK), Taipei Medical University, Taipei, Taiwan
- Division of Nephrology, Department of Internal Medicine, Shuang-Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Ming-Tsang Chuang
- Clinical Data Center, Office of Data Science, Taipei Medical University, Taipei, Taiwan
| | - Yi-Cheng Lin
- Department of Pharmacy, Taipei Medical University Hospital, Taipei, Taiwan
- School of Pharmacy, College of Pharmacy, Taipei Medical University, Taipei, Taiwan
| | - Chun-Yao Huang
- Division of Cardiology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Division of Cardiology, Department of Internal Medicine and Cardiovascular Research Center, Taipei Medical University Hospital, Taipei, Taiwan
- Taipei Heart institute, Taipei Medical University, Taipei, Taiwan
| | - Wei-Chiao Chang
- Division of Nephrology, Department of Internal Medicine, Shuang-Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Department of Clinical Pharmacy, School of Pharmacy, Taipei Medical University, Taipei, Taiwan
- Master Program for Clinical Pharmacogenomics and Pharmacoproteomics, School of Pharmacy, Taipei Medical University, Taipei, Taiwan
| | - Chih-Wei Chen
- Division of Cardiology, Department of Internal Medicine and Cardiovascular Research Center, Taipei Medical University Hospital, Taipei, Taiwan
- Taipei Heart institute, Taipei Medical University, Taipei, Taiwan
- * E-mail:
| | - Tzu-Hao Chang
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan
- Clinical Big Data Research Center, Taipei Medical University Hospital, Taipei, Taiwan
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11
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Avogaro A, Barillà F, Cavalot F, Consoli A, Federici M, Mancone M, Paolillo S, Pedrinelli R, Perseghin G, Perrone Filardi P, Scicali R, Sinagra G, Spaccarotella C, Indolfi C, Purrello F. Cardiovascular risk management in type 2 diabetes mellitus: A joint position paper of the Italian Cardiology (SIC) and Italian Diabetes (SID) Societies. Nutr Metab Cardiovasc Dis 2021; 31:1671-1690. [PMID: 33994263 DOI: 10.1016/j.numecd.2021.02.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 02/23/2021] [Indexed: 12/12/2022]
Abstract
AIM This review represents a joint effort of the Italian Societies of Cardiology (SIC) and Diabetes (SID) to define the state of the art in a field of great clinical and scientific interest which is experiencing a moment of major cultural advancements, the cardiovascular risk management in type 2 diabetes mellitus. DATA SYNTHESIS Consists of six chapters that examine various aspects of pathophysiology, diagnosis and therapy which in recent months have seen numerous scientific innovations and several clinical studies that require extensive sharing. CONCLUSIONS The continuous evolution of our knowledge in this field confirms the great cultural vitality of these two cultural spheres, which requires, under the leadership of the scientific Societies, an ever greater and effective collaboration.
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Affiliation(s)
- Angelo Avogaro
- Dipartimento di Medicina, Sezione di Diabete e Malattia del Metabolismo, Università di Padova, Italy
| | - Francesco Barillà
- Dipartimento di Medicina dei Sistemi, Università di Roma Tor Vergata, Italy
| | - Franco Cavalot
- SSD Malattie Metaboliche e Diabetologia, AOU San Luigi Gonzaga, Orbassano (Torino), Italy
| | - Agostino Consoli
- Department of Medicine and Ageing Sciences and CeSI-Met, University D'Annunzio, Chieti, Italy
| | - Massimo Federici
- Dipartimento di Medicina dei Sistemi, Università di Roma Tor Vergata, Italy
| | - Massimo Mancone
- Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche e Cardiovascolari, Sapienza Università di Roma, Policlinico Umberto I (Roma), Italy
| | - Stefania Paolillo
- Dipartimento di Scienze Biomediche Avanzate, Sezione di Cardiologia, Università degli Studi di Napoli Federico II, Italy; Mediterranea Cardiocentro, Napoli, Italy
| | - Roberto Pedrinelli
- Dipartimento di Patologia Chirurgica, Medica, Molecolare e dell'Area Critica, Università di Pisa, Italy
| | - Gianluca Perseghin
- Dipartimento di Medicina e Riabilitazione, Policlinico di Monza, Università degli Studi di Milano Bicocca, Italy
| | - Pasquale Perrone Filardi
- Dipartimento di Scienze Biomediche Avanzate, Sezione di Cardiologia, Università degli Studi di Napoli Federico II, Italy; Mediterranea Cardiocentro, Napoli, Italy
| | - Roberto Scicali
- Dipartimento di Medicina Clinica e Sperimentale, Università di Catania, Italy
| | - Gianfranco Sinagra
- Cardiovascular Department 'Ospedali Riuniti' and University of Trieste, Trieste, Italy
| | | | - Ciro Indolfi
- Division of Cardiology, University Magna Graecia, Catanzaro, Italy; Mediterranea Cardiocentro, Napoli, Italy.
| | - Francesco Purrello
- Dipartimento di Medicina Clinica e Sperimentale, Università di Catania, Italy.
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12
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Lau WL. Controversies: Stroke Prevention in Chronic Kidney Disease. J Stroke Cerebrovasc Dis 2021; 30:105679. [PMID: 33640261 DOI: 10.1016/j.jstrokecerebrovasdis.2021.105679] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 02/04/2021] [Accepted: 02/10/2021] [Indexed: 11/17/2022] Open
Abstract
Risk of both ischemic and hemorrhagic stroke is increased in the chronic kidney disease (CKD) population, particularly in end-stage kidney disease patients. Uremic factors that contribute to stroke risk include blood pressure variability, vascular calcification, build-up of vascular toxins, chronic inflammation, platelet dysfunction and increased brain microbleeds. This paper discusses the controversial evidence for stroke prevention strategies including blood pressure control, statins, antiplatelet agents, and anticoagulation in the CKD population. Only a few randomized clinical trials included patients with advanced CKD, thus evidence is derived mostly from observational cohorts and real-world data. Overall, targeting a lower systolic blood pressure below 120 mmHg and statin prescription do not appear to decrease stroke risk in CKD. Antiplatelet agents have not shown a clear benefit for secondary stroke prevention, but aspirin may reduce incident stroke in hypertensive CKD stage 3B-5 patients. Observational data suggests that the factor Xa inhibitor apixaban has a favorable profile over warfarin in dialysis patients with atrial fibrillation; apixaban being associated with lower stroke risk and fewer major bleeding events.
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Affiliation(s)
- Wei Ling Lau
- Division of Nephrology and Hypertension, University of California Irvine, Irvine, 333 City Blvd West, Suite 400, Orange, CA, USA.
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13
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Cosentino F, Grant PJ, Aboyans V, Bailey CJ, Ceriello A, Delgado V, Federici M, Filippatos G, Grobbee DE, Hansen TB, Huikuri HV, Johansson I, Jüni P, Lettino M, Marx N, Mellbin LG, Östgren CJ, Rocca B, Roffi M, Sattar N, Seferović PM, Sousa-Uva M, Valensi P, Wheeler DC. 2019 ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD. Eur Heart J 2021; 41:255-323. [PMID: 31497854 DOI: 10.1093/eurheartj/ehz486] [Citation(s) in RCA: 2306] [Impact Index Per Article: 768.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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14
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Capodanno D, Angiolillo DJ. Antithrombotic Therapy for Atherosclerotic Cardiovascular Disease Risk Mitigation in Patients With Coronary Artery Disease and Diabetes Mellitus. Circulation 2020; 142:2172-2188. [PMID: 33253005 DOI: 10.1161/circulationaha.120.045465] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Patients with diabetes mellitus (DM) are characterized by enhanced thrombotic risk attributed to multiple mechanisms including hyperreactive platelets, hypercoagulable status, and endothelial dysfunction. As such, they are more prone to atherosclerotic cardiovascular events than patients without DM, both before and after coronary artery disease (CAD) is established. In patients with DM without established CAD, primary prevention with aspirin is not routinely advocated because of its increased risk of major bleeding that largely offsets its ischemic benefit. In patients with DM with established CAD, secondary prevention with antiplatelet drugs is an asset of pharmacological strategies aimed at reducing the risk of atherosclerotic cardiovascular events and their adverse prognostic consequences. Such antithrombotic strategies include single antiplatelet therapy (eg, with aspirin or a P2Y12 inhibitor), dual antiplatelet therapy (eg, aspirin combined with a P2Y12 inhibitor), and dual-pathway inhibition (eg, aspirin combined with the vascular dose of the direct oral anticoagulant rivaroxaban) for patients with chronic ischemic heart disease, acute coronary syndromes, and those undergoing percutaneous coronary intervention. Because of their increased risk of thrombotic complications, patients with DM commonly achieve enhanced absolute benefit from more potent antithrombotic approaches compared with those without DM, which most often occurs at the expense of increased bleeding. Nevertheless, studies have shown that when excluding individuals at high risk for bleeding, the net clinical benefit favors the use of intensified long-term antithrombotic therapy in patients with DM and CAD. Several studies are ongoing to establish the role of novel antithrombotic strategies and drug formulations in maximizing the net benefit of antithrombotic therapy for patients with DM. The scope of this review article is to provide an overview of current and evolving antithrombotic strategies for primary and secondary prevention of atherosclerotic cardiovascular events in patients with CAD and DM.
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Affiliation(s)
- Davide Capodanno
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico-San Marco," University of Catania, Italy (D.C.)
| | - Dominick J Angiolillo
- Division of Cardiology, University of Florida College of Medicine, Jacksonville (D.J.A.)
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15
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Miglinas M, Cesniene U, Janusaite MM, Vinikovas A. Cerebrovascular Disease and Cognition in Chronic Kidney Disease Patients. Front Cardiovasc Med 2020; 7:96. [PMID: 32582768 PMCID: PMC7283453 DOI: 10.3389/fcvm.2020.00096] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 05/06/2020] [Indexed: 12/16/2022] Open
Abstract
Chronic kidney disease (CKD) affects both brain structure and function. Patients with CKD have a higher risk of both ischemic and hemorrhagic strokes. Age, prior disease history, hypertension, diabetes, atrial fibrillation, smoking, diet, obesity, and sedimentary lifestyle are most common risk factors. Renal-specific pathophysiologic derangements, such as oxidative stress, chronic inflammation, endothelial dysfunction, vascular calcification, anemia, gut dysbiosis, and uremic toxins are important mediators. Dialysis initiation constitutes the highest stroke risk period. CKD significantly worsens stroke outcomes. It is essential to understand the risks and benefits of established stroke therapeutics in patients with CKD, especially in those on dialysis. Subclinical cerebrovascular disease, such as of silent brain infarction, white matter lesions, cerebral microbleeds, and cerebral atrophy are more prevalent with declining renal function. This may lead to functional brain damage manifesting as cognitive impairment. Cognitive dysfunction has been linked to poor compliance with medications, and is associated with greater morbidity and mortality. Thus, understanding the interaction between renal impairment and brain is important in to minimize the risk of neurologic injury in patients with CKD. This article reviews the link between chronic kidney disease and brain abnormalities associated with CKD in detail.
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Affiliation(s)
- Marius Miglinas
- Nephrology and Kidney Transplantation Unit, Nephrology Center, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania.,Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Ugne Cesniene
- Nephrology and Kidney Transplantation Unit, Nephrology Center, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Marta Monika Janusaite
- Nephrology and Kidney Transplantation Unit, Nephrology Center, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania.,Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Arturas Vinikovas
- Nephrology and Kidney Transplantation Unit, Nephrology Center, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania.,Faculty of Medicine, Vilnius University, Vilnius, Lithuania
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16
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Guía ESC 2019 sobre diabetes, prediabetes y enfermedad cardiovascular, en colaboración con la European Association for the Study of Diabetes (EASD). Rev Esp Cardiol 2020. [DOI: 10.1016/j.recesp.2019.11.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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17
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Koziolova NA, Karavaev PG, Veklich AS. [Choosing Antithrombotic Therapy in Patients with Coronary Heart Disease and Type 2 Diabetes Mellitus: How to Reduce the Risk of Death]. KARDIOLOGIIA 2020; 60:109-119. [PMID: 32394865 DOI: 10.18087/cardio.2020.4.n1042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 03/18/2020] [Indexed: 06/11/2023]
Abstract
This review presents prevalence of type 2 diabetes mellitus (DM) in patients with ischemic heart disease (IHD), risk factors in common, and a considerable worsening of prognosis in their combination. The authors addressed pathophysiological mechanisms of platelet dysfunction and negative changes in the coagulation system in IHD patients with type 2 DM, which predetermine activation of the prothrombotic pathway of hemostasis formation. Difficulties in optimal selection of antithrombotic therapy were demonstrated for both patients with type 2 DM without a history of cardiovascular diseases and IHD patients with type 2 DM. The authors paid attention to the fact that results of randomized clinical studies (RCS) that included patients with type 2 DM and acute coronary syndrome or after coronary revascularization cannot be extrapolated to the entire population of patients with stable IHD. At present, the preferable choice of antithrombotic therapy for patients with type 2 DM and stable IHD is a combination of rivaroxaban 2.5 mg twice a day and acetylsalicylic acid 100 mg/day. This combination provides a maximal clinical benefit compared to other strategies presented in RCS.
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Affiliation(s)
- N A Koziolova
- State funded educational institution of the highest education "E.A. Wagner Perm State Medical University" Public Health Ministry of Russian Federation, Perm, Russia
| | - P G Karavaev
- State funded educational institution of the highest education "E.A. Wagner Perm State Medical University" Public Health Ministry of Russian Federation, Perm, Russia
| | - A S Veklich
- State funded educational institution of the highest education "E.A. Wagner Perm State Medical University" Public Health Ministry of Russian Federation, Perm, Russia
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18
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Su X, Yan B, Wang L, Lv J, Cheng H, Chen Y. Effect of antiplatelet therapy on cardiovascular and kidney outcomes in patients with chronic kidney disease: a systematic review and meta-analysis. BMC Nephrol 2019; 20:309. [PMID: 31390997 PMCID: PMC6686545 DOI: 10.1186/s12882-019-1499-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 07/29/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The benefits and risks of antiplatelet therapy for patients with chronic kidney disease (CKD) remain controversial. We undertook a systematic review and meta-analysis to investigate the effects of antiplatelet therapy on major clinical outcomes. METHODS We systematically searched MEDLINE, Embase, and the Cochrane Library for trials published before April 2019 without language restriction. We included rrandomized controlled trials that involved adults with CKD and compared antiplatelet agents with controls. RESULTS Fifty eligible trials that included at least one event were identified, providing data for 27773patients with CKD, including 4518 major cardiovascular events and 1962 all-cause deaths. Antiplatelet therapy produced a 15% (OR, 0.85; 95% CI 0.74-0.94) reduction in the odds of major cardiovascular events (P = 0.002), a 48% reduction for access failure events (OR, 0.52; 95% CI, 0.31-0.73), but had no significantly effect on all-cause death (OR, 0.87; 95% CI, 0.71-1.01) or kidney failure events (OR, 0.87; 95% CI, 0.32-1.55). Adverse events were significantly increased by antiplatelet therapy, including major (OR, 1.33; 95% CI, 1.11-1.59) or minor bleeding (OR, 1.66; 95% CI, 1.27-2.05). Among every 1000 persons with CKD treated with antiplatelet therapy for 12 months, 23 major cardiovascular events will be prevented while nine major bleeding events will occur. CONCLUSIONS Major prevention with antiplatelet agents (cardiovascular events and access failure), might outweigh the risk of bleeding, and there seemed to be an overall net benefit. Individual evaluation and careful monitoring are required.
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Affiliation(s)
- Xiaole Su
- Division of Nephrology, Beijing Anzhen Hospital, Capital Medical University, No. 2, Anzhen Street, Chaoyang District, Beijing, China.,Division of Nephrology, Shanxi Medical University Second Hospital, Shanxi Kidney Disease Institute, No.382, Wuyi Road, Xinghualing Distirct, Taiyuan, China
| | - Bingjuan Yan
- Division of Nephrology, Shanxi Medical University Second Hospital, Shanxi Kidney Disease Institute, No.382, Wuyi Road, Xinghualing Distirct, Taiyuan, China
| | - Lihua Wang
- Division of Nephrology, Shanxi Medical University Second Hospital, Shanxi Kidney Disease Institute, No.382, Wuyi Road, Xinghualing Distirct, Taiyuan, China
| | - Jicheng Lv
- Division of Nephrology, Peking University First Hospital, Peking University Institute of Nephrology, No.8, Xishiku Street, Xicheng District, Beijing, China
| | - Hong Cheng
- Division of Nephrology, Beijing Anzhen Hospital, Capital Medical University, No. 2, Anzhen Street, Chaoyang District, Beijing, China
| | - Yipu Chen
- Division of Nephrology, Beijing Anzhen Hospital, Capital Medical University, No. 2, Anzhen Street, Chaoyang District, Beijing, China.
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19
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Baber U, Li SX, Pinnelas R, Pocock SJ, Krucoff MW, Ariti C, Gibson CM, Steg PG, Weisz G, Witzenbichler B, Henry TD, Kini AS, Stuckey T, Cohen DJ, Iakovou I, Dangas G, Aquino MB, Sartori S, Chieffo A, Moliterno DJ, Colombo A, Mehran R. Incidence, Patterns, and Impact of Dual Antiplatelet Therapy Cessation Among Patients With and Without Chronic Kidney Disease Undergoing Percutaneous Coronary Intervention: Results From the PARIS Registry (Patterns of Non-Adherence to Anti-Platelet Regimens in Stented Patients). Circ Cardiovasc Interv 2019; 11:e006144. [PMID: 29870385 DOI: 10.1161/circinterventions.117.006144] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 02/15/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND Patients with chronic kidney disease (CKD) experience high rates of ischemic and bleeding events after percutaneous coronary intervention (PCI), complicating decisions surrounding dual antiplatelet therapy (DAPT). This study aims to determine the pattern and impact of various modes of DAPT cessation for patients with CKD undergoing PCI. METHODS AND RESULTS Patients from the PARIS registry (Patterns of Non-Adherence to Anti-Platelet Regimens in Stented Patients) were grouped based on the presence of CKD defined as creatinine clearance <60 mL/min. After index PCI, time and mode of DAPT cessation (discontinuation, interruption, and disruption) and clinical outcomes (major adverse cardiac events, stent thrombosis, myocardial infarction, and major bleeding [Bleeding Academic Research Consortium type 3 or 5]) were reported. Over 2 years, patients with CKD (n=839) had higher adjusted risks for death (hazard ratio, 3.16; 95% confidence interval, 2.26-4.41), myocardial infarction (hazard ratio, 2.43; 95% confidence interval, 1.65-3.57), and major bleeding (hazard ratio, 2.21; 95% confidence interval, 1.53-3.19) compared with patients without CKD (n=3745). Rates of DAPT discontinuation within the first year after PCI and disruption were significantly higher for patients with CKD. However, DAPT interruption occurred with equal frequency. Associations between DAPT cessation mode and subsequent risk were not modified by CKD status. Findings were unchanged after propensity matching. CONCLUSIONS Patients with CKD display high and comparable risks for both ischemic and bleeding events after PCI. Physicians are more likely to discontinue DAPT within the first year after PCI among patients with CKD, likely reflecting clinical preferences to avoid bleeding. Risks after DAPT cessation, irrespective of underlying mode, are not modified by the presence or absence of CKD.
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Affiliation(s)
- Usman Baber
- From the Mount Sinai School of Medicine, New York, NY (U.B., A.S.K., G.D., M.B.A., S.S., R.M.); Dartmouth Geisel School of Medicine, Hanover, NH (S.X.L.); New York University Medical Center (R.P.); London School of Hygiene and Tropical Medicine, United Kingdom (S.J.P., C.A.); Duke University School of Medicine, Durham, NC (M.W.K.); Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts (C.M.G.); Université Paris-Diderot, Sorbonne Paris-Cité, Paris, France (P.G.S.); Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); Moses Cone Memorial Hospital, Greensboro, NC (T.S.); Saint Luke's Mid America Heart Institute, Kansas City, MO (D.J.C.); Onassis Cardiac Surgery Center, Athens, Greece (I.I.); San Raffaele Scientific Institute, Milan, Italy (A. Chieffo, A. Colombo); and University of Kentucky, Lexington (D.J.M.)
| | - Shawn X Li
- From the Mount Sinai School of Medicine, New York, NY (U.B., A.S.K., G.D., M.B.A., S.S., R.M.); Dartmouth Geisel School of Medicine, Hanover, NH (S.X.L.); New York University Medical Center (R.P.); London School of Hygiene and Tropical Medicine, United Kingdom (S.J.P., C.A.); Duke University School of Medicine, Durham, NC (M.W.K.); Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts (C.M.G.); Université Paris-Diderot, Sorbonne Paris-Cité, Paris, France (P.G.S.); Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); Moses Cone Memorial Hospital, Greensboro, NC (T.S.); Saint Luke's Mid America Heart Institute, Kansas City, MO (D.J.C.); Onassis Cardiac Surgery Center, Athens, Greece (I.I.); San Raffaele Scientific Institute, Milan, Italy (A. Chieffo, A. Colombo); and University of Kentucky, Lexington (D.J.M.)
| | - Rebecca Pinnelas
- From the Mount Sinai School of Medicine, New York, NY (U.B., A.S.K., G.D., M.B.A., S.S., R.M.); Dartmouth Geisel School of Medicine, Hanover, NH (S.X.L.); New York University Medical Center (R.P.); London School of Hygiene and Tropical Medicine, United Kingdom (S.J.P., C.A.); Duke University School of Medicine, Durham, NC (M.W.K.); Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts (C.M.G.); Université Paris-Diderot, Sorbonne Paris-Cité, Paris, France (P.G.S.); Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); Moses Cone Memorial Hospital, Greensboro, NC (T.S.); Saint Luke's Mid America Heart Institute, Kansas City, MO (D.J.C.); Onassis Cardiac Surgery Center, Athens, Greece (I.I.); San Raffaele Scientific Institute, Milan, Italy (A. Chieffo, A. Colombo); and University of Kentucky, Lexington (D.J.M.)
| | - Stuart J Pocock
- From the Mount Sinai School of Medicine, New York, NY (U.B., A.S.K., G.D., M.B.A., S.S., R.M.); Dartmouth Geisel School of Medicine, Hanover, NH (S.X.L.); New York University Medical Center (R.P.); London School of Hygiene and Tropical Medicine, United Kingdom (S.J.P., C.A.); Duke University School of Medicine, Durham, NC (M.W.K.); Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts (C.M.G.); Université Paris-Diderot, Sorbonne Paris-Cité, Paris, France (P.G.S.); Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); Moses Cone Memorial Hospital, Greensboro, NC (T.S.); Saint Luke's Mid America Heart Institute, Kansas City, MO (D.J.C.); Onassis Cardiac Surgery Center, Athens, Greece (I.I.); San Raffaele Scientific Institute, Milan, Italy (A. Chieffo, A. Colombo); and University of Kentucky, Lexington (D.J.M.)
| | - Mitchell W Krucoff
- From the Mount Sinai School of Medicine, New York, NY (U.B., A.S.K., G.D., M.B.A., S.S., R.M.); Dartmouth Geisel School of Medicine, Hanover, NH (S.X.L.); New York University Medical Center (R.P.); London School of Hygiene and Tropical Medicine, United Kingdom (S.J.P., C.A.); Duke University School of Medicine, Durham, NC (M.W.K.); Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts (C.M.G.); Université Paris-Diderot, Sorbonne Paris-Cité, Paris, France (P.G.S.); Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); Moses Cone Memorial Hospital, Greensboro, NC (T.S.); Saint Luke's Mid America Heart Institute, Kansas City, MO (D.J.C.); Onassis Cardiac Surgery Center, Athens, Greece (I.I.); San Raffaele Scientific Institute, Milan, Italy (A. Chieffo, A. Colombo); and University of Kentucky, Lexington (D.J.M.)
| | - Cono Ariti
- From the Mount Sinai School of Medicine, New York, NY (U.B., A.S.K., G.D., M.B.A., S.S., R.M.); Dartmouth Geisel School of Medicine, Hanover, NH (S.X.L.); New York University Medical Center (R.P.); London School of Hygiene and Tropical Medicine, United Kingdom (S.J.P., C.A.); Duke University School of Medicine, Durham, NC (M.W.K.); Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts (C.M.G.); Université Paris-Diderot, Sorbonne Paris-Cité, Paris, France (P.G.S.); Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); Moses Cone Memorial Hospital, Greensboro, NC (T.S.); Saint Luke's Mid America Heart Institute, Kansas City, MO (D.J.C.); Onassis Cardiac Surgery Center, Athens, Greece (I.I.); San Raffaele Scientific Institute, Milan, Italy (A. Chieffo, A. Colombo); and University of Kentucky, Lexington (D.J.M.)
| | - C Michael Gibson
- From the Mount Sinai School of Medicine, New York, NY (U.B., A.S.K., G.D., M.B.A., S.S., R.M.); Dartmouth Geisel School of Medicine, Hanover, NH (S.X.L.); New York University Medical Center (R.P.); London School of Hygiene and Tropical Medicine, United Kingdom (S.J.P., C.A.); Duke University School of Medicine, Durham, NC (M.W.K.); Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts (C.M.G.); Université Paris-Diderot, Sorbonne Paris-Cité, Paris, France (P.G.S.); Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); Moses Cone Memorial Hospital, Greensboro, NC (T.S.); Saint Luke's Mid America Heart Institute, Kansas City, MO (D.J.C.); Onassis Cardiac Surgery Center, Athens, Greece (I.I.); San Raffaele Scientific Institute, Milan, Italy (A. Chieffo, A. Colombo); and University of Kentucky, Lexington (D.J.M.)
| | - Philippe Gabriel Steg
- From the Mount Sinai School of Medicine, New York, NY (U.B., A.S.K., G.D., M.B.A., S.S., R.M.); Dartmouth Geisel School of Medicine, Hanover, NH (S.X.L.); New York University Medical Center (R.P.); London School of Hygiene and Tropical Medicine, United Kingdom (S.J.P., C.A.); Duke University School of Medicine, Durham, NC (M.W.K.); Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts (C.M.G.); Université Paris-Diderot, Sorbonne Paris-Cité, Paris, France (P.G.S.); Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); Moses Cone Memorial Hospital, Greensboro, NC (T.S.); Saint Luke's Mid America Heart Institute, Kansas City, MO (D.J.C.); Onassis Cardiac Surgery Center, Athens, Greece (I.I.); San Raffaele Scientific Institute, Milan, Italy (A. Chieffo, A. Colombo); and University of Kentucky, Lexington (D.J.M.)
| | - Giora Weisz
- From the Mount Sinai School of Medicine, New York, NY (U.B., A.S.K., G.D., M.B.A., S.S., R.M.); Dartmouth Geisel School of Medicine, Hanover, NH (S.X.L.); New York University Medical Center (R.P.); London School of Hygiene and Tropical Medicine, United Kingdom (S.J.P., C.A.); Duke University School of Medicine, Durham, NC (M.W.K.); Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts (C.M.G.); Université Paris-Diderot, Sorbonne Paris-Cité, Paris, France (P.G.S.); Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); Moses Cone Memorial Hospital, Greensboro, NC (T.S.); Saint Luke's Mid America Heart Institute, Kansas City, MO (D.J.C.); Onassis Cardiac Surgery Center, Athens, Greece (I.I.); San Raffaele Scientific Institute, Milan, Italy (A. Chieffo, A. Colombo); and University of Kentucky, Lexington (D.J.M.)
| | - Bernhard Witzenbichler
- From the Mount Sinai School of Medicine, New York, NY (U.B., A.S.K., G.D., M.B.A., S.S., R.M.); Dartmouth Geisel School of Medicine, Hanover, NH (S.X.L.); New York University Medical Center (R.P.); London School of Hygiene and Tropical Medicine, United Kingdom (S.J.P., C.A.); Duke University School of Medicine, Durham, NC (M.W.K.); Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts (C.M.G.); Université Paris-Diderot, Sorbonne Paris-Cité, Paris, France (P.G.S.); Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); Moses Cone Memorial Hospital, Greensboro, NC (T.S.); Saint Luke's Mid America Heart Institute, Kansas City, MO (D.J.C.); Onassis Cardiac Surgery Center, Athens, Greece (I.I.); San Raffaele Scientific Institute, Milan, Italy (A. Chieffo, A. Colombo); and University of Kentucky, Lexington (D.J.M.)
| | - Timothy D Henry
- From the Mount Sinai School of Medicine, New York, NY (U.B., A.S.K., G.D., M.B.A., S.S., R.M.); Dartmouth Geisel School of Medicine, Hanover, NH (S.X.L.); New York University Medical Center (R.P.); London School of Hygiene and Tropical Medicine, United Kingdom (S.J.P., C.A.); Duke University School of Medicine, Durham, NC (M.W.K.); Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts (C.M.G.); Université Paris-Diderot, Sorbonne Paris-Cité, Paris, France (P.G.S.); Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); Moses Cone Memorial Hospital, Greensboro, NC (T.S.); Saint Luke's Mid America Heart Institute, Kansas City, MO (D.J.C.); Onassis Cardiac Surgery Center, Athens, Greece (I.I.); San Raffaele Scientific Institute, Milan, Italy (A. Chieffo, A. Colombo); and University of Kentucky, Lexington (D.J.M.)
| | - Annapoorna S Kini
- From the Mount Sinai School of Medicine, New York, NY (U.B., A.S.K., G.D., M.B.A., S.S., R.M.); Dartmouth Geisel School of Medicine, Hanover, NH (S.X.L.); New York University Medical Center (R.P.); London School of Hygiene and Tropical Medicine, United Kingdom (S.J.P., C.A.); Duke University School of Medicine, Durham, NC (M.W.K.); Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts (C.M.G.); Université Paris-Diderot, Sorbonne Paris-Cité, Paris, France (P.G.S.); Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); Moses Cone Memorial Hospital, Greensboro, NC (T.S.); Saint Luke's Mid America Heart Institute, Kansas City, MO (D.J.C.); Onassis Cardiac Surgery Center, Athens, Greece (I.I.); San Raffaele Scientific Institute, Milan, Italy (A. Chieffo, A. Colombo); and University of Kentucky, Lexington (D.J.M.)
| | - Thomas Stuckey
- From the Mount Sinai School of Medicine, New York, NY (U.B., A.S.K., G.D., M.B.A., S.S., R.M.); Dartmouth Geisel School of Medicine, Hanover, NH (S.X.L.); New York University Medical Center (R.P.); London School of Hygiene and Tropical Medicine, United Kingdom (S.J.P., C.A.); Duke University School of Medicine, Durham, NC (M.W.K.); Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts (C.M.G.); Université Paris-Diderot, Sorbonne Paris-Cité, Paris, France (P.G.S.); Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); Moses Cone Memorial Hospital, Greensboro, NC (T.S.); Saint Luke's Mid America Heart Institute, Kansas City, MO (D.J.C.); Onassis Cardiac Surgery Center, Athens, Greece (I.I.); San Raffaele Scientific Institute, Milan, Italy (A. Chieffo, A. Colombo); and University of Kentucky, Lexington (D.J.M.)
| | - David J Cohen
- From the Mount Sinai School of Medicine, New York, NY (U.B., A.S.K., G.D., M.B.A., S.S., R.M.); Dartmouth Geisel School of Medicine, Hanover, NH (S.X.L.); New York University Medical Center (R.P.); London School of Hygiene and Tropical Medicine, United Kingdom (S.J.P., C.A.); Duke University School of Medicine, Durham, NC (M.W.K.); Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts (C.M.G.); Université Paris-Diderot, Sorbonne Paris-Cité, Paris, France (P.G.S.); Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); Moses Cone Memorial Hospital, Greensboro, NC (T.S.); Saint Luke's Mid America Heart Institute, Kansas City, MO (D.J.C.); Onassis Cardiac Surgery Center, Athens, Greece (I.I.); San Raffaele Scientific Institute, Milan, Italy (A. Chieffo, A. Colombo); and University of Kentucky, Lexington (D.J.M.)
| | - Ioannis Iakovou
- From the Mount Sinai School of Medicine, New York, NY (U.B., A.S.K., G.D., M.B.A., S.S., R.M.); Dartmouth Geisel School of Medicine, Hanover, NH (S.X.L.); New York University Medical Center (R.P.); London School of Hygiene and Tropical Medicine, United Kingdom (S.J.P., C.A.); Duke University School of Medicine, Durham, NC (M.W.K.); Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts (C.M.G.); Université Paris-Diderot, Sorbonne Paris-Cité, Paris, France (P.G.S.); Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); Moses Cone Memorial Hospital, Greensboro, NC (T.S.); Saint Luke's Mid America Heart Institute, Kansas City, MO (D.J.C.); Onassis Cardiac Surgery Center, Athens, Greece (I.I.); San Raffaele Scientific Institute, Milan, Italy (A. Chieffo, A. Colombo); and University of Kentucky, Lexington (D.J.M.)
| | - George Dangas
- From the Mount Sinai School of Medicine, New York, NY (U.B., A.S.K., G.D., M.B.A., S.S., R.M.); Dartmouth Geisel School of Medicine, Hanover, NH (S.X.L.); New York University Medical Center (R.P.); London School of Hygiene and Tropical Medicine, United Kingdom (S.J.P., C.A.); Duke University School of Medicine, Durham, NC (M.W.K.); Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts (C.M.G.); Université Paris-Diderot, Sorbonne Paris-Cité, Paris, France (P.G.S.); Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); Moses Cone Memorial Hospital, Greensboro, NC (T.S.); Saint Luke's Mid America Heart Institute, Kansas City, MO (D.J.C.); Onassis Cardiac Surgery Center, Athens, Greece (I.I.); San Raffaele Scientific Institute, Milan, Italy (A. Chieffo, A. Colombo); and University of Kentucky, Lexington (D.J.M.)
| | - Melissa B Aquino
- From the Mount Sinai School of Medicine, New York, NY (U.B., A.S.K., G.D., M.B.A., S.S., R.M.); Dartmouth Geisel School of Medicine, Hanover, NH (S.X.L.); New York University Medical Center (R.P.); London School of Hygiene and Tropical Medicine, United Kingdom (S.J.P., C.A.); Duke University School of Medicine, Durham, NC (M.W.K.); Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts (C.M.G.); Université Paris-Diderot, Sorbonne Paris-Cité, Paris, France (P.G.S.); Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); Moses Cone Memorial Hospital, Greensboro, NC (T.S.); Saint Luke's Mid America Heart Institute, Kansas City, MO (D.J.C.); Onassis Cardiac Surgery Center, Athens, Greece (I.I.); San Raffaele Scientific Institute, Milan, Italy (A. Chieffo, A. Colombo); and University of Kentucky, Lexington (D.J.M.)
| | - Samantha Sartori
- From the Mount Sinai School of Medicine, New York, NY (U.B., A.S.K., G.D., M.B.A., S.S., R.M.); Dartmouth Geisel School of Medicine, Hanover, NH (S.X.L.); New York University Medical Center (R.P.); London School of Hygiene and Tropical Medicine, United Kingdom (S.J.P., C.A.); Duke University School of Medicine, Durham, NC (M.W.K.); Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts (C.M.G.); Université Paris-Diderot, Sorbonne Paris-Cité, Paris, France (P.G.S.); Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); Moses Cone Memorial Hospital, Greensboro, NC (T.S.); Saint Luke's Mid America Heart Institute, Kansas City, MO (D.J.C.); Onassis Cardiac Surgery Center, Athens, Greece (I.I.); San Raffaele Scientific Institute, Milan, Italy (A. Chieffo, A. Colombo); and University of Kentucky, Lexington (D.J.M.)
| | - Alaide Chieffo
- From the Mount Sinai School of Medicine, New York, NY (U.B., A.S.K., G.D., M.B.A., S.S., R.M.); Dartmouth Geisel School of Medicine, Hanover, NH (S.X.L.); New York University Medical Center (R.P.); London School of Hygiene and Tropical Medicine, United Kingdom (S.J.P., C.A.); Duke University School of Medicine, Durham, NC (M.W.K.); Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts (C.M.G.); Université Paris-Diderot, Sorbonne Paris-Cité, Paris, France (P.G.S.); Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); Moses Cone Memorial Hospital, Greensboro, NC (T.S.); Saint Luke's Mid America Heart Institute, Kansas City, MO (D.J.C.); Onassis Cardiac Surgery Center, Athens, Greece (I.I.); San Raffaele Scientific Institute, Milan, Italy (A. Chieffo, A. Colombo); and University of Kentucky, Lexington (D.J.M.)
| | - David J Moliterno
- From the Mount Sinai School of Medicine, New York, NY (U.B., A.S.K., G.D., M.B.A., S.S., R.M.); Dartmouth Geisel School of Medicine, Hanover, NH (S.X.L.); New York University Medical Center (R.P.); London School of Hygiene and Tropical Medicine, United Kingdom (S.J.P., C.A.); Duke University School of Medicine, Durham, NC (M.W.K.); Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts (C.M.G.); Université Paris-Diderot, Sorbonne Paris-Cité, Paris, France (P.G.S.); Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); Moses Cone Memorial Hospital, Greensboro, NC (T.S.); Saint Luke's Mid America Heart Institute, Kansas City, MO (D.J.C.); Onassis Cardiac Surgery Center, Athens, Greece (I.I.); San Raffaele Scientific Institute, Milan, Italy (A. Chieffo, A. Colombo); and University of Kentucky, Lexington (D.J.M.)
| | - Antonio Colombo
- From the Mount Sinai School of Medicine, New York, NY (U.B., A.S.K., G.D., M.B.A., S.S., R.M.); Dartmouth Geisel School of Medicine, Hanover, NH (S.X.L.); New York University Medical Center (R.P.); London School of Hygiene and Tropical Medicine, United Kingdom (S.J.P., C.A.); Duke University School of Medicine, Durham, NC (M.W.K.); Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts (C.M.G.); Université Paris-Diderot, Sorbonne Paris-Cité, Paris, France (P.G.S.); Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); Moses Cone Memorial Hospital, Greensboro, NC (T.S.); Saint Luke's Mid America Heart Institute, Kansas City, MO (D.J.C.); Onassis Cardiac Surgery Center, Athens, Greece (I.I.); San Raffaele Scientific Institute, Milan, Italy (A. Chieffo, A. Colombo); and University of Kentucky, Lexington (D.J.M.)
| | - Roxana Mehran
- From the Mount Sinai School of Medicine, New York, NY (U.B., A.S.K., G.D., M.B.A., S.S., R.M.); Dartmouth Geisel School of Medicine, Hanover, NH (S.X.L.); New York University Medical Center (R.P.); London School of Hygiene and Tropical Medicine, United Kingdom (S.J.P., C.A.); Duke University School of Medicine, Durham, NC (M.W.K.); Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts (C.M.G.); Université Paris-Diderot, Sorbonne Paris-Cité, Paris, France (P.G.S.); Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); Moses Cone Memorial Hospital, Greensboro, NC (T.S.); Saint Luke's Mid America Heart Institute, Kansas City, MO (D.J.C.); Onassis Cardiac Surgery Center, Athens, Greece (I.I.); San Raffaele Scientific Institute, Milan, Italy (A. Chieffo, A. Colombo); and University of Kentucky, Lexington (D.J.M.).
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20
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Mavrakanas TA, Chatzizisis YS, Gariani K, Kereiakes DJ, Gargiulo G, Helft G, Gilard M, Feres F, Costa RA, Morice MC, Georges JL, Valgimigli M, Bhatt DL, Mauri L, Charytan DM. Duration of Dual Antiplatelet Therapy in Patients with CKD and Drug-Eluting Stents: A Meta-Analysis. Clin J Am Soc Nephrol 2019; 14:810-822. [PMID: 31010936 PMCID: PMC6556713 DOI: 10.2215/cjn.12901018] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 03/27/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND OBJECTIVES Whether prolonged dual antiplatelet therapy (DAPT) is more protective in patients with CKD and drug-eluting stents compared with shorter DAPT is uncertain. The purpose of this meta-analysis was to examine whether shorter DAPT in patients with drug-eluting stents and CKD is associated with lower mortality or major adverse cardiovascular event rates compared with longer DAPT. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS A Medline literature research was conducted to identify randomized trials in patients with drug-eluting stents comparing different DAPT duration strategies. Inclusion of patients with CKD was also required. The primary outcome was a composite of all-cause mortality, myocardial infarction, stroke, or stent thrombosis (definite or probable). Major bleeding was the secondary outcome. The risk ratio (RR) was estimated using a random-effects model. RESULTS Five randomized trials were included (1902 patients with CKD). Short DAPT (≤6 months) was associated with a similar incidence of the primary outcome, compared with 12-month DAPT among patients with CKD (48 versus 50 events; RR, 0.93; 95% confidence interval [95% CI], 0.64 to 1.36; P=0.72). Twelve-month DAPT was also associated with a similar incidence of the primary outcome compared with extended DAPT (≥30 months) in the CKD subgroup (35 versus 35 events; RR, 1.04; 95% CI, 0.67 to 1.62; P=0.87). Numerically lower major bleeding event rates were detected with shorter versus 12-month DAPT (9 versus 13 events; RR, 0.69; 95% CI, 0.30 to 1.60; P=0.39) and 12-month versus extended DAPT (9 versus 12 events; RR, 0.83; 95% CI, 0.35 to 1.93; P=0.66) in patients with CKD. CONCLUSIONS Short DAPT does not appear to be inferior to longer DAPT in patients with CKD and drug-eluting stents. Because of imprecision in estimates (few events and wide confidence intervals), no definite conclusions can be drawn with respect to stent thrombosis.
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Affiliation(s)
- Thomas A Mavrakanas
- Renal Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; .,Department of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | | | - Karim Gariani
- Division of Diabetes and Endocrinology, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Dean J Kereiakes
- The Christ Hospital Heart and Vascular Center and The Lindner Center for Research and Education, Cincinnati, Ohio
| | - Giuseppe Gargiulo
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland.,Department of Advanced Biomedical Sciences, University Federico II of Naples, Naples, Italy
| | - Gérard Helft
- Institute of Cardiology, University Hospitals Pitié-Salpêtrière- Charles Foix (Public Assistance- Hospitals of Paris), Sorbonne University, Paris, France
| | - Martine Gilard
- Division of Cardiology, Regional University Hospital La Cavale Blanche, Brest, France
| | - Fausto Feres
- Institute Dante Pazzanese de Cardiologia, Sao Paulo, Sao Paulo, Brazil
| | - Ricardo A Costa
- Institute Dante Pazzanese de Cardiologia, Sao Paulo, Sao Paulo, Brazil
| | | | | | - Marco Valgimigli
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Deepak L Bhatt
- Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, Massachusetts
| | - Laura Mauri
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - David M Charytan
- Renal Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.,Baim Institute for Clinical Research, Boston, Massachusetts; and.,Division of Nephrology, New York University Langone Medical Center, New York, New York
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21
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Patti G, Cavallari I, Andreotti F, Calabrò P, Cirillo P, Denas G, Galli M, Golia E, Maddaloni E, Marcucci R, Parato VM, Pengo V, Prisco D, Ricottini E, Renda G, Santilli F, Simeone P, De Caterina R. Prevention of atherothrombotic events in patients with diabetes mellitus: from antithrombotic therapies to new-generation glucose-lowering drugs. Nat Rev Cardiol 2019; 16:113-130. [PMID: 30250166 PMCID: PMC7136162 DOI: 10.1038/s41569-018-0080-2] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Diabetes mellitus is an important risk factor for a first cardiovascular event and for worse outcomes after a cardiovascular event has occurred. This situation might be caused, at least in part, by the prothrombotic status observed in patients with diabetes. Therefore, contemporary antithrombotic strategies, including more potent agents or drug combinations, might provide greater clinical benefit in patients with diabetes than in those without diabetes. In this Consensus Statement, our Working Group explores the mechanisms of platelet and coagulation activity, the current debate on antiplatelet therapy in primary cardiovascular disease prevention, and the benefit of various antithrombotic approaches in secondary prevention of cardiovascular disease in patients with diabetes. While acknowledging that current data are often derived from underpowered, observational studies or subgroup analyses of larger trials, we propose antithrombotic strategies for patients with diabetes in various cardiovascular settings (primary prevention, stable coronary artery disease, acute coronary syndromes, ischaemic stroke and transient ischaemic attack, peripheral artery disease, atrial fibrillation, and venous thromboembolism). Finally, we summarize the improvements in cardiovascular outcomes observed with the latest glucose-lowering drugs, and on the basis of the available evidence, we expand and integrate current guideline recommendations on antithrombotic strategies in patients with diabetes for both primary and secondary prevention of cardiovascular disease.
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Affiliation(s)
- Giuseppe Patti
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy.
| | - Ilaria Cavallari
- Unit of Cardiovascular Science, Campus Bio-Medico University, Rome, Italy
| | - Felicita Andreotti
- Cardiovascular and Thoracic Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Paolo Calabrò
- Department of Cardio-thoracic and Respiratory Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Plinio Cirillo
- Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Gentian Denas
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Mattia Galli
- Cardiovascular and Thoracic Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Enrica Golia
- Department of Cardio-thoracic and Respiratory Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Ernesto Maddaloni
- Department of Medicine, Unit of Endocrinology and Diabetes, Campus Bio-Medico University, Rome, Italy
| | - Rossella Marcucci
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Vito Maurizio Parato
- Cardiology Unit, Madonna del Soccorso Hospital, San Benedetto del Tronto, Italy
- Politecnica Delle Marche University, San Benedetto del Tronto, Italy
| | - Vittorio Pengo
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Domenico Prisco
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | | | - Giulia Renda
- Institute of Cardiology, G. d'Annunzio University, Chieti, Italy
| | - Francesca Santilli
- Department of Medicine and Aging, G. d'Annunzio University, Chieti, Italy
| | - Paola Simeone
- Department of Medicine and Aging, G. d'Annunzio University, Chieti, Italy
| | - Raffaele De Caterina
- Institute of Cardiology, G. d'Annunzio University, Chieti, Italy.
- Fondazione G. Monasterio, Pisa, Italy.
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22
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Zheng Z, Ma T, Lian X, Gao J, Wang W, Weng W, Lu X, Sun W, Cheng Y, Fu Y, Rane MJ, Gozal E, Cai L. Clopidogrel Reduces Fibronectin Accumulation and Improves Diabetes-Induced Renal Fibrosis. Int J Biol Sci 2019; 15:239-252. [PMID: 30662363 PMCID: PMC6329922 DOI: 10.7150/ijbs.29063] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 11/11/2018] [Indexed: 12/18/2022] Open
Abstract
Hyperglycemia-induced renal fibrosis causes end-stage renal disease. Clopidogrel, a platelet inhibitor, is often administered to decrease cardiovascular events in diabetic patients. We investigated whether clopidogrel can reduce diabetes-induced renal fibrosis in a streptozotocin-induced type 1 diabetes murine model and fibronectin involvement in this protective response. Diabetic and age-matched controls were sacrificed three months after the onset of diabetes, and additional controls and diabetic animals were further treated with clopidogrel or vehicle for three months. Diabetes induced renal morphological changes and fibrosis after three months. Clopidogrel, administered during the last three months, significantly decreased blood glucose, collagen and fibronectin expression compared to vehicle-treated diabetic mice. Diabetes increased TGF-β expression, inducing fibrosis via Smad-independent pathways, MAP kinases, and Akt activation at three months but returned to baseline at six months, whereas the expression of fibronectin and collagen remained elevated. Our results suggest that activation of TGF-β, CTGF, and MAP kinases are early profibrotic signaling events, resulting in significant fibronectin accumulation at the early time point and returning to baseline at a later time point. Akt activation at the three-month time point may serve as an adaptive response in T1D. Mechanisms of clopidogrel therapeutic effect on the diabetic kidney remain to be investigated as this clinically approved compound could provide novel approaches to prevent diabetes-induced renal disease, therefore improving patients' survival.
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Affiliation(s)
- Zongyu Zheng
- Department of Urology, The First Hospital of Jilin University, Changchun 130021, China
- Pediatric Research Institute, Department of Pediatrics, University of Louisville, Louisville, KY 40202, USA
| | - Tianjiao Ma
- Pediatric Research Institute, Department of Pediatrics, University of Louisville, Louisville, KY 40202, USA
- Department of Rheumatology and Immunology, China-Japan Union Hospital of the Jilin University, Changchun 130033, China
| | - Xin Lian
- Department of Urology, The First Hospital of Jilin University, Changchun 130021, China
| | - Jialin Gao
- Department of Urology, The First Hospital of Jilin University, Changchun 130021, China
| | - Weigang Wang
- Department of Urology, The First Hospital of Jilin University, Changchun 130021, China
| | - Wenya Weng
- Pediatric Research Institute, Department of Pediatrics, University of Louisville, Louisville, KY 40202, USA
- The Ruian Center of Chinese-American Research Institute for Diabetic Complications, The Third Affiliated Hospital of the Wenzhou Medical University, Ruian 325200, China
| | - Xuemian Lu
- The Ruian Center of Chinese-American Research Institute for Diabetic Complications, The Third Affiliated Hospital of the Wenzhou Medical University, Ruian 325200, China
| | - Weixia Sun
- Department of Nephrology, The First Hospital of Jilin University, Changchun 130021, China
| | - Yanli Cheng
- Department of Nephrology, The First Hospital of Jilin University, Changchun 130021, China
| | - Yaowen Fu
- Department of Urology, The First Hospital of Jilin University, Changchun 130021, China
| | - Madhavi J. Rane
- Division of Nephrology, Department of Medicine, University of Louisville, Louisville, KY 40202, USA
| | - Evelyne Gozal
- Pediatric Research Institute, Department of Pediatrics, University of Louisville, Louisville, KY 40202, USA
- Departments of Pharmacology and Toxicology, University of Louisville, Louisville, KY 40202, USA
| | - Lu Cai
- Pediatric Research Institute, Department of Pediatrics, University of Louisville, Louisville, KY 40202, USA
- Departments of Pharmacology and Toxicology, University of Louisville, Louisville, KY 40202, USA
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Bonello L, Angiolillo DJ, Aradi D, Sibbing D. P2Y
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-ADP Receptor Blockade in Chronic Kidney Disease Patients With Acute Coronary Syndromes. Circulation 2018; 138:1582-1596. [DOI: 10.1161/circulationaha.118.032078] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Laurent Bonello
- Aix-Marseille Université, INSERM UMR-S 1076, Vascular Research Center of Marseille, Marseille, France (L.B.)
| | - Dominick J. Angiolillo
- Division of Cardiology, University of Florida College of Medicine, Jacksonville (D.J.A.)
| | - Daniel Aradi
- Heart Center Balatonfüred and Semmelweis University Budapest, Hungary (D.A.)
| | - Dirk Sibbing
- Department of Cardiology, Ludwig-Maximilians-Universität München, Germany (D.S.)
- DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Germany (D.S.)
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Carrizzo A, Izzo C, Oliveti M, Alfano A, Virtuoso N, Capunzo M, Di Pietro P, Calabrese M, De Simone E, Sciarretta S, Frati G, Migliarino S, Damato A, Ambrosio M, De Caro F, Vecchione C. The Main Determinants of Diabetes Mellitus Vascular Complications: Endothelial Dysfunction and Platelet Hyperaggregation. Int J Mol Sci 2018; 19:ijms19102968. [PMID: 30274207 PMCID: PMC6212935 DOI: 10.3390/ijms19102968] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 09/26/2018] [Accepted: 09/27/2018] [Indexed: 12/24/2022] Open
Abstract
Diabetes mellitus is a common disease that affects 3–5% of the general population in Italy. In some countries of northern Europe or in North America, it can even affect 6–8% of the population. Of great concern is that the number of cases of diabetes is constantly increasing, probably due to the increase in obesity and the sedentary nature of the population. According to the World Health Organization, in the year 2030 there will be 360 million people with diabetes, compared to 170 million in 2000. This has important repercussions on the lives of patients and their families, and on health systems that offer assistance to patients. In this review, we try to describe in an organized way the pathophysiological continuity between diabetes mellitus, endothelial dysfunction, and platelet hyperaggregation, highlighting the main molecular mechanisms involved and the interconnections.
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Affiliation(s)
| | - Carmine Izzo
- Departement of Medicine and Surgery, University of Salerno, 84081 Baronissi, SA, Italy.
| | - Marco Oliveti
- Departement of Medicine and Surgery, University of Salerno, 84081 Baronissi, SA, Italy.
| | - Antonia Alfano
- Heart Department, A.O.U. "San Giovanni di Dio e Ruggi d'Aragona", 84131 Salerno, Italy.
| | - Nicola Virtuoso
- Department of Cardiovascular Medicine, A.O.U. Federico II, 80131 Naples, Italy.
| | - Mario Capunzo
- Departement of Medicine and Surgery, University of Salerno, 84081 Baronissi, SA, Italy.
| | - Paola Di Pietro
- Departement of Medicine and Surgery, University of Salerno, 84081 Baronissi, SA, Italy.
| | | | - Eros De Simone
- Heart Department, A.O.U. "San Giovanni di Dio e Ruggi d'Aragona", 84131 Salerno, Italy.
| | - Sebastiano Sciarretta
- IRCCS Neuromed, 86077 Pozzilli, IS, Italy.
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, 00161 Rome, Italy.
| | - Giacomo Frati
- IRCCS Neuromed, 86077 Pozzilli, IS, Italy.
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, 00161 Rome, Italy.
| | - Serena Migliarino
- Department of Clinical and Molecular Medicine, School of Medicine and Psychology, Sapienza University of Rome, 00161 Rome, Italy.
| | | | | | - Francesco De Caro
- Departement of Medicine and Surgery, University of Salerno, 84081 Baronissi, SA, Italy.
| | - Carmine Vecchione
- IRCCS Neuromed, 86077 Pozzilli, IS, Italy.
- Departement of Medicine and Surgery, University of Salerno, 84081 Baronissi, SA, Italy.
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Thomas MC. Perspective Review: Type 2 Diabetes and Readmission for Heart Failure. CLINICAL MEDICINE INSIGHTS-CARDIOLOGY 2018; 12:1179546818779588. [PMID: 29899670 PMCID: PMC5992798 DOI: 10.1177/1179546818779588] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 04/30/2018] [Indexed: 12/13/2022]
Abstract
Heart failure is a leading cause for hospitalisation and for readmission, especially in patients over the age of 65. Diabetes is an increasingly common companion to heart failure. The presence of diabetes and its associated comorbidity increases the risk of adverse outcomes and premature mortality in patients with heart failure. In particular, patients with diabetes are more likely to be readmitted to hospital soon after discharge. This may partly reflect the greater severity of heart disease in these patients. In addition, agents that reduce the chances of readmission such as β-blockers, renin-angiotensin-aldosterone system blockers, and mineralocorticoid receptor antagonists are underutilised because of the perceived increased risks of adverse drug reactions and other limitations. In some cases, readmission to hospital is precipitated by acute decompensation of heart failure (re-exacerbation) leading to pulmonary congestion and/or refractory oedema. However, it appears that for most of the patients admitted and then discharged with a primary diagnosis of heart failure, most readmissions are not due to heart failure, but rather due to comorbidity including arrhythmia, infection, adverse drug reactions, and renal impairment/reduced hydration. All of these are more common in patients who also have diabetes, and all may be partly preventable. The many different reasons for readmission underline the critical value of multidisciplinary comprehensive care in patients admitted with heart failure, especially those with diabetes. A number of new strategies are also being developed to address this area of need, including the use of SGLT2 inhibitors, novel nonsteroidal mineralocorticoid antagonists, and neprilysin inhibitors.
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Affiliation(s)
- Merlin C Thomas
- Department of Diabetes, Central Clinical School, Monash University, Melbourne, VIC, Australia
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Breet N, Jong CD, Bos WJ, van Werkum J, Bouman H, Kelder J, Bergmeijer T, Zijlstra F, Hackeng C, ten Berg J. The impact of renal function on platelet reactivity and clinical outcome in patients undergoing percutaneous coronary intervention with stenting. Thromb Haemost 2017; 112:1174-81. [DOI: 10.1160/th14-04-0302] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Accepted: 06/20/2014] [Indexed: 12/23/2022]
Abstract
SummaryPatients with chronic kidney disease (CKD) have an increased risk of cardiovascular disease. Previous studies have suggested that patients with CKD have less therapeutic benefit of antiplatelet therapy. However, the relation between renal function and platelet reactivity is still under debate. On-treatment platelet reactivity was determined in parallel by ADP- and AA-induced light transmittance aggregometry (LTA) and the VerifyNow® System (P2Y12 and Aspirin) in 988 patients on dual antiplatelet therapy, undergoing elective coronary stenting. Patients were divided into two groups according to the presence or absence of moderate/severe CKD (GFR<60 ml/min/1.73 m2). Furthermore, the incidence of all-cause death, non-fatal acute myocardial infarction, stent thrombosis and stroke at one-year was evaluated. Patients with CKD (n=180) had significantly higher platelet reactivity, regardless of the platelet function test used. Patients with CKD more frequently had high on-clopidogrel platelet reactivity (HCPR) and high on-aspirin platelet reactivity (HAPR) regardless of the platelet function test used. After adjustment for potential confounders, this was no longer significant. The event-rate was the highest in patients with both high on-treatment platelet reactivity (HPR) and CKD compared to those with neither high on-treatment platelet reactivity nor CKD. In conclusion, the magnitude of platelet reactivity as well as the incidence of HPR was higher in patients with CKD. However, since the incidence of HPR was similar after adjustment, a higher rate of co-morbidities in patients with CKD might be the major cause for this observation rather than CKD itself. CKD-patients with HCPR were at the highest risk of long-term cardiovascular events.Clinical Trial Registration: www.clinicaltrials.gov: NCT00352014.
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Wang H, Qi J, Li Y, Tang Y, Li C, Li J, Han Y. Pharmacodynamics and pharmacokinetics of ticagrelor vs. clopidogrel in patients with acute coronary syndromes and chronic kidney disease. Br J Clin Pharmacol 2017; 84:88-96. [PMID: 28921624 DOI: 10.1111/bcp.13436] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Revised: 08/29/2017] [Accepted: 09/11/2017] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Pivotal clinical trials found that ticagrelor reduced ischaemic complications to a greater extent than clopidogrel, and also that the benefit gradually increased with the reduction in creatinine clearance. However, the underlying mechanisms remains poorly explored. METHODS This was a single-centre, prospective, randomized clinical trial involving 60 hospitalized Adenosine Diphosphate (ADP) P2Y12 receptor inhibitor-naïve patients with chronic kidney disease (CKD) (estimated glomerular filtration rate <60 ml min-1 1.73 m-2 ) and non-ST-elevation acute coronary syndromes (NSTE-ACS). Eligible patients were randomly assigned in a 1:1 ratio to receive ticagrelor (180 mg loading dose, then followed by 90 mg twice daily) or clopidogrel (600 mg loading dose, then followed by 75 mg once daily). The primary endpoint was the P2Y12 reactive unit (PRU) value assessed by VerifyNow at 30 days. The plasma concentrations of ticagrelor and clopidogrel and their active metabolites were measured in the first 10 patients in each group at baseline, and at 1 h, 2 h, 4 h, 8 h, 12 h and 24 h after the loading dose. RESULTS Baseline characteristics were well matched between the two groups. Our results indicated a markedly lower PRU in patients treated with ticagrelor vs. clopidogrel at 30 days (32.6 ± 11.29 vs. 203.7 ± 17.92; P < 0.001) as well as at 2 h, 8 h and 24 h after the loading dose (P < 0.001). Ticagrelor and its active metabolite AR-C124910XX showed a similar time to reach maximum concentration (Cmax ) of 8 h, with the maximum concentration (Cmax ) of 355 (242.50-522.00) ng ml-1 and 63.20 (50.80-85.15) ng ml-1 , respectively. Both clopidogrel and its active metabolite approached the Cmax at 2 h, with a similar Cmax of 8.67 (6.64-27.75) ng ml-1 vs. 8.53 (6.94-15.93) ng ml-1 . CONCLUSION Ticagrelor showed much more potent platelet inhibition in comparison with clopidogrel in patients with CKD and NSTE-ACS.
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Affiliation(s)
- Heyang Wang
- General Hospital of Shenyang Military Region, Shenyang, China
| | - Jing Qi
- General Hospital of Shenyang Military Region, Shenyang, China
| | - Yi Li
- General Hospital of Shenyang Military Region, Shenyang, China
| | - Yunbiao Tang
- General Hospital of Shenyang Military Region, Shenyang, China
| | - Chao Li
- General Hospital of Shenyang Military Region, Shenyang, China
| | - Jing Li
- General Hospital of Shenyang Military Region, Shenyang, China
| | - Yaling Han
- General Hospital of Shenyang Military Region, Shenyang, China
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Murrone A, Santucci A, Cavallini C. Primary and secondary prevention in diabetic patients. J Cardiovasc Med (Hagerstown) 2017; 18 Suppl 1:e83-e90. [DOI: 10.2459/jcm.0000000000000453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Jain N, Reilly RF. Oral P2Y12Receptor Inhibitors in Hemodialysis Patients Undergoing Percutaneous Coronary Interventions: Current Knowledge and Future Directions. Semin Dial 2016; 29:374-81. [DOI: 10.1111/sdi.12484] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Nishank Jain
- Kidney Institute; University of Kansas Medical Center; Kansas City Kansas
| | - Robert F. Reilly
- Division of Nephrology; Medical Service; Veterans Affairs North Texas Health Care System; Dallas Texas
- Division of Nephrology; Department of Medicine; University of Texas Southwestern Medical Center; Dallas Texas
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Crimi G, Leonardi S, Costa F, Adamo M, Ariotti S, Valgimigli M. Role of stent type and of duration of dual antiplatelet therapy in patients with chronic kidney disease undergoing percutaneous coronary interventions. Is bare metal stent implantation still a justifiable choice? A post-hoc analysis of the all comer PRODIGY trial. Int J Cardiol 2016; 212:110-7. [PMID: 27038714 DOI: 10.1016/j.ijcard.2016.03.033] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2015] [Revised: 03/04/2016] [Accepted: 03/13/2016] [Indexed: 11/19/2022]
Abstract
AIM Chronic kidney disease (CKD) is a powerful predictor of major cardiovascular events and stent thrombosis (ST) in patients undergoing percutaneous coronary interventions (PCI). No randomized data are available to compare, and guide the selection of type of stent between bare metal (BMS) or drug eluting stent (DES) in this population. METHODS AND RESULTS We performed a post-hoc analysis of the PROlonging Dual antiplatelet treatment after Grading stent-induced Intimal hyperplasia studY (PRODIGY) trial, in which stable or unstable patients with coronary artery disease undergoing PCI were randomized 1:1:1:1 to receive BMS, paclitaxel- (PES), zotarolimus- (ZES-S), or everolimus- (EES) eluting stent. A total of 2003 patients were randomized, and 22 patients were excluded for missing serum creatinine leading to a final population of 1981 patients. Primary outcome was definite or probable ST. We also assessed MACE (myocardial infarction, stroke, or death), and all-cause death, as secondary outcome. CKD, defined with estimated glomerular filtration rate <60ml/min/1.73m(2), was found in 373 patients (18.8%). The incidence of ST at 2years was 5.1% in CKD and 2.1% in non-CKD patients (HR 2.57, 95% confidence interval (CI) 1.46 to 4.52, p<0.001). At multivariable regression we found that patients randomized to EES or ZES-S, but not PES, had lower risk of ST at two years as compared with BMS: adjusted HR=0.288, 95% CI [0.107-0.778, p=0.014] and HR=0.394, 95% CI [0.164-0.947, p=0.037] respectively. The number of patients needed to be treated to prevent 1 ST with an EES vs BMS was 20 in CKD and 50 in patients without CKD. EES patients had the lowest incident MACE events 26.4% as compared to BMS 35.1%, ZES-S 33.0%, or PES 35.7% patients, p=0.551. All-cause death was lowest in ZES-S group 10.6% as compared to BMS 18.1%, PES 25.5% and EES 14.9%, p=0.040. We found no significant interaction between DAPT duration (6 vs 24months) and stent type on primary outcome, PINT=0.47 for BMS, PINT=0.57 for PES, PINT=0.41 for ZES-S and PINT=0.28 for EES. CONCLUSIONS In an all-comer population of patients with stable and unstable CAD, CKD at baseline was associated with a double risk of ST and MACE. CKD patients receiving EES had less than half risk of ST 2years after PCI as compared with BMS and PES. Our analysis suggests that 2nd generation limus-based stent should be favored over paclitaxel-based DES or BMS to reduce ST and MACE in CKD patients.
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Affiliation(s)
- Gabriele Crimi
- SC. Cardiologia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Sergio Leonardi
- SC. Cardiologia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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Abstract
Diabetes imparts a substantial increased risk for cardiovascular disease-related mortality and morbidity. Because of this, current medical guidelines recommend prophylactic treatment with once-daily, low-dose aspirin (acetylsalicylic acid) for primary and secondary prevention of cardiovascular (CV) events in high-risk patients. However, only modest reductions in CV events and mortality have been observed with once-daily aspirin treatment in patients with diabetes, including patients with a previous CV event, perhaps because of disparity between aspirin pharmacokinetics and diabetes-related platelet abnormalities. Once-daily aspirin irreversibly inactivates platelets for only a short duration (acetylsalicylic acid half-life, approximately 15-20 minutes), after which time newly generated, active platelets enter the circulation and weaken aspirin's effect. Platelets from patients with diabetes are more reactive and are turned over more rapidly than platelets from normal individuals; the short inhibitory window provided by once-daily aspirin may therefore be insufficient to provide 24-h protection against CV events. Alternative conventional aspirin regimens (e.g. higher daily dose, twice-daily dosing, combination with clopidogrel) and newer formulations (e.g. 24-h, extended-release) have been proposed to overcome the apparent limited efficacy of conventional aspirin in patients with diabetes; however, tolerability concerns and limited clinical efficacy data need to be taken into account when considering the use of such regimens.
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Danchin N, Puymirat E, Schiele F. Antithrombotic therapy for stable coronary artery disease: the difficult quest for the holy balance. Eur Heart J 2015; 37:409-11. [DOI: 10.1093/eurheartj/ehv471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Mittal M, Aggarwal K, Littrell RL, Agrawal H, Alpert MA. Does pharmacotherapy improve cardiovascular outcomes in hemodialysis patients? Hemodial Int 2015; 19 Suppl 3:S40-50. [DOI: 10.1111/hdi.12352] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Mayank Mittal
- Division of Cardiovascular Medicine; University of Missouri School of Medicine; Columbia Missouri USA
| | - Kul Aggarwal
- Division of Cardiovascular Medicine; University of Missouri School of Medicine; Columbia Missouri USA
| | - Rachel L. Littrell
- Division of Cardiovascular Medicine; University of Missouri School of Medicine; Columbia Missouri USA
| | - Harsh Agrawal
- Division of Cardiovascular Medicine; University of Missouri School of Medicine; Columbia Missouri USA
| | - Martin A. Alpert
- Division of Cardiovascular Medicine; University of Missouri School of Medicine; Columbia Missouri USA
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Magnani G, Storey RF, Steg G, Bhatt DL, Cohen M, Kuder J, Im K, Aylward P, Ardissino D, Isaza D, Parkhomenko A, Goudev AR, Dellborg M, Kontny F, Corbalan R, Medina F, Jensen EC, Held P, Braunwald E, Sabatine MS, Bonaca MP. Efficacy and safety of ticagrelor for long-term secondary prevention of atherothrombotic events in relation to renal function: insights from the PEGASUS-TIMI 54 trial. Eur Heart J 2015; 37:400-8. [PMID: 26443023 DOI: 10.1093/eurheartj/ehv482] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Accepted: 08/25/2015] [Indexed: 11/12/2022] Open
Abstract
AIMS We evaluated the relationship of renal function and ischaemic and bleeding risk as well as the efficacy and safety of ticagrelor in stable patients with prior myocardial infarction (MI). METHODS AND RESULTS Patients with a history of MI 1-3 years prior from PEGASUS-TIMI 54 were stratified based on estimated glomerular filtration rate (eGFR), with <60 mL/min/1.73 m(2) pre-specified for analysis of the effect of ticagrelor on the primary efficacy composite of cardiovascular death, MI, or stroke (major adverse cardiovascular events, MACE) and the primary safety endpoint of TIMI major bleeding. Of 20 898 patients, those with eGFR <60 (N = 4849, 23.2%) had a greater risk of MACE at 3 years relative to those without, which remained significant after multivariable adjustment (hazard ratio, HRadj 1.54, 95% confidence interval, CI 1.27-1.85, P < 0.001). The relative risk reduction in MACE with ticagrelor was similar in those with eGFR <60 (ticagrelor pooled vs. placebo: HR 0.81; 95% CI 0.68-0.96) vs. ≥60 (HR 0.88; 95% CI 0.77-1.00, Pinteraction = 0.44). However, due to the greater absolute risk in the former group, the absolute risk reduction with ticagrelor was higher: 2.7 vs. 0.63%. Bleeding tended to occur more frequently in patients with renal dysfunction. The absolute increase in TIMI major bleeding with ticagrelor was similar in those with and without eGFR <60 (1.19 vs. 1.43%), whereas the excess of minor bleeding tended to be more pronounced (1.93 vs. 0.69%). CONCLUSION In patients with a history of MI, patients with renal dysfunction are at increased risk of MACE and consequently experience a particularly robust absolute risk reduction with long-term treatment with ticagrelor.
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Affiliation(s)
- Giulia Magnani
- TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA, USA
| | - Robert F Storey
- Department of Cardiovascular Science, University of Sheffield, Sheffield, UK
| | - Gabriel Steg
- Cardiology Department, DHU-FIRE, Hôpital Bichat, Paris, France Université Paris-Diderot, Paris, France INSERM U1148, Paris, France
| | - Deepak L Bhatt
- TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA, USA
| | - Marc Cohen
- Cardiovascular Division, Department of Medicine, Rutgers-New Jersey Medical School, New York, USA
| | - Julia Kuder
- TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA, USA
| | - Kyungah Im
- TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA, USA
| | - Philip Aylward
- Division of Medicine, Cardiac & Critical Care Services, Flinders University and Medical Centre, Adelaide, Australia
| | - Diego Ardissino
- Cardiovascular Division, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | | | | | - Assen R Goudev
- Department of Cardiology, Queen Giovanna University Hospital, Sofia, Bulgaria
| | - Mikael Dellborg
- Department of Molecular and Clinical Medicine/Cardiology, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Frederic Kontny
- Department of Cardiology, Stavanger University Hospital, Stavanger, Norway
| | - Ramon Corbalan
- Cardiovascular Division, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Felix Medina
- Hospital Nacional Cayetano Heredia, San Martin de Porres, Lima, Peru
| | | | | | - Eugene Braunwald
- TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA, USA
| | - Marc S Sabatine
- TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA, USA
| | - Marc P Bonaca
- TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA, USA
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Clinical Practice Guideline on management of patients with diabetes and chronic kidney disease stage 3b or higher (eGFR <45 mL/min). Nephrol Dial Transplant 2015; 30 Suppl 2:ii1-142. [PMID: 25940656 DOI: 10.1093/ndt/gfv100] [Citation(s) in RCA: 96] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Jiang XL, Samant S, Lesko LJ, Schmidt S. Clinical pharmacokinetics and pharmacodynamics of clopidogrel. Clin Pharmacokinet 2015; 54:147-66. [PMID: 25559342 DOI: 10.1007/s40262-014-0230-6] [Citation(s) in RCA: 123] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Acute coronary syndromes (ACS) remain life-threatening disorders, which are associated with high morbidity and mortality. Dual antiplatelet therapy with aspirin and clopidogrel has been shown to reduce cardiovascular events in patients with ACS. However, there is substantial inter-individual variability in the response to clopidogrel treatment, in addition to prolonged recovery of platelet reactivity as a result of irreversible binding to P2Y12 receptors. This high inter-individual variability in treatment response has primarily been associated with genetic polymorphisms in the genes encoding for cytochrome (CYP) 2C19, which affect the pharmacokinetics of clopidogrel. While the US Food and Drug Administration has issued a boxed warning for CYP2C19 poor metabolizers because of potentially reduced efficacy in these patients, results from multivariate analyses suggest that additional factors, including age, sex, obesity, concurrent diseases and drug-drug interactions, may all contribute to the overall between-subject variability in treatment response. However, the extent to which each of these factors contributes to the overall variability, and how they are interrelated, is currently unclear. The objective of this review article is to provide a comprehensive update on the different factors that influence the pharmacokinetics and pharmacodynamics of clopidogrel and how they mechanistically contribute to inter-individual differences in the response to clopidogrel treatment.
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Affiliation(s)
- Xi-Ling Jiang
- Department of Pharmaceutics, Center for Pharmacometrics and Systems Pharmacology, University of Florida at Lake Nona (Orlando), 6550 Sanger Road, Room 467, Orlando, FL, 32827, USA
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Abstract
The kidney is arguably the most important target of microvascular damage in diabetes. A substantial proportion of individuals with diabetes will develop kidney disease owing to their disease and/or other co-morbidity, including hypertension and ageing-related nephron loss. The presence and severity of chronic kidney disease (CKD) identify individuals who are at increased risk of adverse health outcomes and premature mortality. Consequently, preventing and managing CKD in patients with diabetes is now a key aim of their overall management. Intensive management of patients with diabetes includes controlling blood glucose levels and blood pressure as well as blockade of the renin-angiotensin-aldosterone system; these approaches will reduce the incidence of diabetic kidney disease and slow its progression. Indeed, the major decline in the incidence of diabetic kidney disease (DKD) over the past 30 years and improved patient prognosis are largely attributable to improved diabetes care. However, there remains an unmet need for innovative treatment strategies to prevent, arrest, treat and reverse DKD. In this Primer, we summarize what is now known about the molecular pathogenesis of CKD in patients with diabetes and the key pathways and targets implicated in its progression. In addition, we discuss the current evidence for the prevention and management of DKD as well as the many controversies. Finally, we explore the opportunities to develop new interventions through urgently needed investment in dedicated and focused research. For an illustrated summary of this Primer, visit: http://go.nature.com/NKHDzg.
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Efficacy and safety of P2Y12 inhibitors according to diabetes, age, gender, body mass index and body weight: Systematic review and meta-analyses of randomized clinical trials. Atherosclerosis 2015; 240:439-45. [DOI: 10.1016/j.atherosclerosis.2015.04.015] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Revised: 04/08/2015] [Accepted: 04/13/2015] [Indexed: 12/17/2022]
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Baber U, Mehran R, Kirtane AJ, Gurbel PA, Christodoulidis G, Maehara A, Witzenbichler B, Weisz G, Rinaldi MJ, Metzger DC, Henry TD, Cox DA, Duffy PL, Mazzaferri EL, Xu K, Parise H, Brodie BR, Stuckey TD, Stone GW. Prevalence and Impact of High Platelet Reactivity in Chronic Kidney Disease. Circ Cardiovasc Interv 2015; 8:e001683. [DOI: 10.1161/circinterventions.115.001683] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Chronic kidney disease (CKD) is associated with increased rates of adverse events after percutaneous coronary intervention. We sought to determine the impact of CKD on platelet reactivity in clopidogrel-treated patients and whether high platelet reactivity (HPR) confers a similar or differential risk for adverse events among patients with CKD and non-CKD.
Methods and Results—
We performed a post hoc analysis of the Assessment of Dual Antiplatelet Therapy With Drug-Eluting Stents (ADAPT-DES) registry, which included 8582 patients undergoing percutaneous coronary intervention with drug-eluting stents and platelet function testing using the VerifyNow assay. We compared HPR and its impact on ischemic and bleeding events >2 years among patients with CKD and non-CKD. Patients with CKD (n=1367) were older, more often female, diabetic, and had lower ejection fraction compared with their non-CKD counterparts (n=7043). Although HPR prevalence increased with worsening renal function in unadjusted analyses, these associations were no longer present after adjustment. Major adverse cardiac event rates at 2 years among those without CKD or HPR, HPR alone, CKD alone, and both CKD and HPR were 9.0%, 11.2%, 13.3%, and 17.5%, respectively (
P
<0.001). Associations between HPR and adverse events were uniform across CKD strata without evidence of interaction.
Conclusions—
HPR is more common among those with versus without CKD, an association that is attributable to confounding risk factors that are more prevalent in CKD. The impact of HPR on ischemic and bleeding events is similar irrespective of CKD status.
Clinical Trial Registration—
URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT00638794.
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Affiliation(s)
- Usman Baber
- From the Icahn School of Medicine at Mount Sinai, New York (U.B., R.M., G.C.); Cardiovascular Research Foundation, New York (R.M., A.J.K., A.M., G.W., K.X., H.P., G.W.S.); NewYork–Presbyterian/Columbia University Medical Center, New York, NY (A.J.K., A.M., G.W., G.W.S.); Sinai Hospital of Baltimore, MD (P.A.G.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Sanger Heart and Vascular Institute/Carolinas HealthCare System, Charlotte, NC (M.J.R.)
| | - Roxana Mehran
- From the Icahn School of Medicine at Mount Sinai, New York (U.B., R.M., G.C.); Cardiovascular Research Foundation, New York (R.M., A.J.K., A.M., G.W., K.X., H.P., G.W.S.); NewYork–Presbyterian/Columbia University Medical Center, New York, NY (A.J.K., A.M., G.W., G.W.S.); Sinai Hospital of Baltimore, MD (P.A.G.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Sanger Heart and Vascular Institute/Carolinas HealthCare System, Charlotte, NC (M.J.R.)
| | - Ajay J. Kirtane
- From the Icahn School of Medicine at Mount Sinai, New York (U.B., R.M., G.C.); Cardiovascular Research Foundation, New York (R.M., A.J.K., A.M., G.W., K.X., H.P., G.W.S.); NewYork–Presbyterian/Columbia University Medical Center, New York, NY (A.J.K., A.M., G.W., G.W.S.); Sinai Hospital of Baltimore, MD (P.A.G.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Sanger Heart and Vascular Institute/Carolinas HealthCare System, Charlotte, NC (M.J.R.)
| | - Paul A. Gurbel
- From the Icahn School of Medicine at Mount Sinai, New York (U.B., R.M., G.C.); Cardiovascular Research Foundation, New York (R.M., A.J.K., A.M., G.W., K.X., H.P., G.W.S.); NewYork–Presbyterian/Columbia University Medical Center, New York, NY (A.J.K., A.M., G.W., G.W.S.); Sinai Hospital of Baltimore, MD (P.A.G.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Sanger Heart and Vascular Institute/Carolinas HealthCare System, Charlotte, NC (M.J.R.)
| | - Georgios Christodoulidis
- From the Icahn School of Medicine at Mount Sinai, New York (U.B., R.M., G.C.); Cardiovascular Research Foundation, New York (R.M., A.J.K., A.M., G.W., K.X., H.P., G.W.S.); NewYork–Presbyterian/Columbia University Medical Center, New York, NY (A.J.K., A.M., G.W., G.W.S.); Sinai Hospital of Baltimore, MD (P.A.G.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Sanger Heart and Vascular Institute/Carolinas HealthCare System, Charlotte, NC (M.J.R.)
| | - Akiko Maehara
- From the Icahn School of Medicine at Mount Sinai, New York (U.B., R.M., G.C.); Cardiovascular Research Foundation, New York (R.M., A.J.K., A.M., G.W., K.X., H.P., G.W.S.); NewYork–Presbyterian/Columbia University Medical Center, New York, NY (A.J.K., A.M., G.W., G.W.S.); Sinai Hospital of Baltimore, MD (P.A.G.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Sanger Heart and Vascular Institute/Carolinas HealthCare System, Charlotte, NC (M.J.R.)
| | - Bernhard Witzenbichler
- From the Icahn School of Medicine at Mount Sinai, New York (U.B., R.M., G.C.); Cardiovascular Research Foundation, New York (R.M., A.J.K., A.M., G.W., K.X., H.P., G.W.S.); NewYork–Presbyterian/Columbia University Medical Center, New York, NY (A.J.K., A.M., G.W., G.W.S.); Sinai Hospital of Baltimore, MD (P.A.G.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Sanger Heart and Vascular Institute/Carolinas HealthCare System, Charlotte, NC (M.J.R.)
| | - Giora Weisz
- From the Icahn School of Medicine at Mount Sinai, New York (U.B., R.M., G.C.); Cardiovascular Research Foundation, New York (R.M., A.J.K., A.M., G.W., K.X., H.P., G.W.S.); NewYork–Presbyterian/Columbia University Medical Center, New York, NY (A.J.K., A.M., G.W., G.W.S.); Sinai Hospital of Baltimore, MD (P.A.G.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Sanger Heart and Vascular Institute/Carolinas HealthCare System, Charlotte, NC (M.J.R.)
| | - Michael J. Rinaldi
- From the Icahn School of Medicine at Mount Sinai, New York (U.B., R.M., G.C.); Cardiovascular Research Foundation, New York (R.M., A.J.K., A.M., G.W., K.X., H.P., G.W.S.); NewYork–Presbyterian/Columbia University Medical Center, New York, NY (A.J.K., A.M., G.W., G.W.S.); Sinai Hospital of Baltimore, MD (P.A.G.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Sanger Heart and Vascular Institute/Carolinas HealthCare System, Charlotte, NC (M.J.R.)
| | - D. Christopher Metzger
- From the Icahn School of Medicine at Mount Sinai, New York (U.B., R.M., G.C.); Cardiovascular Research Foundation, New York (R.M., A.J.K., A.M., G.W., K.X., H.P., G.W.S.); NewYork–Presbyterian/Columbia University Medical Center, New York, NY (A.J.K., A.M., G.W., G.W.S.); Sinai Hospital of Baltimore, MD (P.A.G.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Sanger Heart and Vascular Institute/Carolinas HealthCare System, Charlotte, NC (M.J.R.)
| | - Timothy D. Henry
- From the Icahn School of Medicine at Mount Sinai, New York (U.B., R.M., G.C.); Cardiovascular Research Foundation, New York (R.M., A.J.K., A.M., G.W., K.X., H.P., G.W.S.); NewYork–Presbyterian/Columbia University Medical Center, New York, NY (A.J.K., A.M., G.W., G.W.S.); Sinai Hospital of Baltimore, MD (P.A.G.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Sanger Heart and Vascular Institute/Carolinas HealthCare System, Charlotte, NC (M.J.R.)
| | - David A. Cox
- From the Icahn School of Medicine at Mount Sinai, New York (U.B., R.M., G.C.); Cardiovascular Research Foundation, New York (R.M., A.J.K., A.M., G.W., K.X., H.P., G.W.S.); NewYork–Presbyterian/Columbia University Medical Center, New York, NY (A.J.K., A.M., G.W., G.W.S.); Sinai Hospital of Baltimore, MD (P.A.G.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Sanger Heart and Vascular Institute/Carolinas HealthCare System, Charlotte, NC (M.J.R.)
| | - Peter L. Duffy
- From the Icahn School of Medicine at Mount Sinai, New York (U.B., R.M., G.C.); Cardiovascular Research Foundation, New York (R.M., A.J.K., A.M., G.W., K.X., H.P., G.W.S.); NewYork–Presbyterian/Columbia University Medical Center, New York, NY (A.J.K., A.M., G.W., G.W.S.); Sinai Hospital of Baltimore, MD (P.A.G.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Sanger Heart and Vascular Institute/Carolinas HealthCare System, Charlotte, NC (M.J.R.)
| | - Ernest L. Mazzaferri
- From the Icahn School of Medicine at Mount Sinai, New York (U.B., R.M., G.C.); Cardiovascular Research Foundation, New York (R.M., A.J.K., A.M., G.W., K.X., H.P., G.W.S.); NewYork–Presbyterian/Columbia University Medical Center, New York, NY (A.J.K., A.M., G.W., G.W.S.); Sinai Hospital of Baltimore, MD (P.A.G.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Sanger Heart and Vascular Institute/Carolinas HealthCare System, Charlotte, NC (M.J.R.)
| | - Ke Xu
- From the Icahn School of Medicine at Mount Sinai, New York (U.B., R.M., G.C.); Cardiovascular Research Foundation, New York (R.M., A.J.K., A.M., G.W., K.X., H.P., G.W.S.); NewYork–Presbyterian/Columbia University Medical Center, New York, NY (A.J.K., A.M., G.W., G.W.S.); Sinai Hospital of Baltimore, MD (P.A.G.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Sanger Heart and Vascular Institute/Carolinas HealthCare System, Charlotte, NC (M.J.R.)
| | - Helen Parise
- From the Icahn School of Medicine at Mount Sinai, New York (U.B., R.M., G.C.); Cardiovascular Research Foundation, New York (R.M., A.J.K., A.M., G.W., K.X., H.P., G.W.S.); NewYork–Presbyterian/Columbia University Medical Center, New York, NY (A.J.K., A.M., G.W., G.W.S.); Sinai Hospital of Baltimore, MD (P.A.G.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Sanger Heart and Vascular Institute/Carolinas HealthCare System, Charlotte, NC (M.J.R.)
| | - Bruce R. Brodie
- From the Icahn School of Medicine at Mount Sinai, New York (U.B., R.M., G.C.); Cardiovascular Research Foundation, New York (R.M., A.J.K., A.M., G.W., K.X., H.P., G.W.S.); NewYork–Presbyterian/Columbia University Medical Center, New York, NY (A.J.K., A.M., G.W., G.W.S.); Sinai Hospital of Baltimore, MD (P.A.G.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Sanger Heart and Vascular Institute/Carolinas HealthCare System, Charlotte, NC (M.J.R.)
| | - Thomas D. Stuckey
- From the Icahn School of Medicine at Mount Sinai, New York (U.B., R.M., G.C.); Cardiovascular Research Foundation, New York (R.M., A.J.K., A.M., G.W., K.X., H.P., G.W.S.); NewYork–Presbyterian/Columbia University Medical Center, New York, NY (A.J.K., A.M., G.W., G.W.S.); Sinai Hospital of Baltimore, MD (P.A.G.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Sanger Heart and Vascular Institute/Carolinas HealthCare System, Charlotte, NC (M.J.R.)
| | - Gregg W. Stone
- From the Icahn School of Medicine at Mount Sinai, New York (U.B., R.M., G.C.); Cardiovascular Research Foundation, New York (R.M., A.J.K., A.M., G.W., K.X., H.P., G.W.S.); NewYork–Presbyterian/Columbia University Medical Center, New York, NY (A.J.K., A.M., G.W., G.W.S.); Sinai Hospital of Baltimore, MD (P.A.G.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Sanger Heart and Vascular Institute/Carolinas HealthCare System, Charlotte, NC (M.J.R.)
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Washam JB, Herzog CA, Beitelshees AL, Cohen MG, Henry TD, Kapur NK, Mega JL, Menon V, Page RL, Newby LK. Pharmacotherapy in Chronic Kidney Disease Patients Presenting With Acute Coronary Syndrome. Circulation 2015; 131:1123-49. [DOI: 10.1161/cir.0000000000000183] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Tanios BY, Itani HS, Zimmerman DL. Clopidogrel Use in End-Stage Kidney Disease. Semin Dial 2014; 28:276-81. [DOI: 10.1111/sdi.12338] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Bassem Y. Tanios
- Nephrology Department; Paris Sud University; Le Kremlin Bicêtre France
| | - Houssam S. Itani
- Division of Nephrology; Department of Medicine; University of Ottawa; Ottawa Hospital; Ottawa Ontario Canada
| | - Deborah L. Zimmerman
- Division of Nephrology; Department of Medicine; University of Ottawa; Ottawa Hospital; Ottawa Ontario Canada
- Kidney Research Centre of the Ottawa Hospital Research Institute; Ottawa Ontario Canada
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43
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Takagi K, Chieffo A, Naganuma T, Ielasi A, Fujino Y, Latib A, Fukino K, Montorfano M, Tahara S, Nakamura S, Colombo A. Impact of renal dysfunction on long-term mortality in patients with unprotected left main disease: Milan and New-Tokyo (MITO) Registry. Int J Cardiol 2014; 177:1131-3. [DOI: 10.1016/j.ijcard.2014.08.048] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Accepted: 08/09/2014] [Indexed: 10/24/2022]
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Hart RG, Halperin JL, Weitz JI. Vorapaxar, combination antiplatelet therapy, and stroke. J Am Coll Cardiol 2014; 64:2327-9. [PMID: 25465418 DOI: 10.1016/j.jacc.2014.09.038] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2014] [Accepted: 09/08/2014] [Indexed: 10/24/2022]
Affiliation(s)
- Robert G Hart
- Population Health Research Institute, Hamilton Health Sciences, Department of Medicine (Neurology), McMaster University, Hamilton, Ontario, Canada.
| | - Jonathan L Halperin
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, Mount Sinai Medical Center, New York, New York
| | - Jeffrey I Weitz
- Thrombosis and Atherosclerosis Research Institute, Hamilton Health Sciences, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
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Liang J, Wang Z, Shi D, Liu Y, Zhao Y, Han H, Li Y, Liu W, Zhang L, Yang L, Zhou Y. High clopidogrel dose in patients with chronic kidney disease having clopidogrel resistance after percutaneous coronary intervention. Angiology 2014; 66:319-25. [PMID: 24913197 DOI: 10.1177/0003319714538804] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We evaluated the impact of clopidogrel 150 mg/d in patients with chronic kidney disease (CKD) having clopidogrel resistance (CR) after percutaneous coronary intervention (PCI); 1076 consecutive patients with coronary artery disease (CAD) having CKD were enrolled. Maximal platelet aggregation (MPA) was assessed before, 24 hours, and 30 days after a 300-mg loading dose of clopidogrel prior to PCI. After PCI, 370 patients with CR were randomized to receive clopidogrel 75 mg/d (n = 184) or 150 mg/d (n = 186) for 30 days. Stent thrombosis (ST), major adverse cardiac events (MACEs), and bleeding were analyzed after 1 month. Patients in the 150 mg group had significant lower rates of ST and MACE. There was no significant difference in major or minor bleeding. Patients in the 150 mg group had lower MPA and greater inhibition of platelet aggregation. One-month administration of 150 mg/d of clopidogrel decreases the rate of ST and MACE without increasing bleeding in patients with CKD having CR after PCI.
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Affiliation(s)
- Jing Liang
- Department of Cardiology, Anzhen Hospital, Capital Medical University, Beijing, China
| | - Zhijian Wang
- Department of Cardiology, Anzhen Hospital, Capital Medical University, Beijing, China
| | - Dongmei Shi
- Department of Cardiology, Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yuyang Liu
- Department of Cardiology, Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yingxin Zhao
- Department of Cardiology, Anzhen Hospital, Capital Medical University, Beijing, China
| | - Hongya Han
- Department of Cardiology, Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yueping Li
- Department of Cardiology, Anzhen Hospital, Capital Medical University, Beijing, China
| | - Wei Liu
- Department of Cardiology, Anzhen Hospital, Capital Medical University, Beijing, China
| | - Linlin Zhang
- Department of Cardiology, Anzhen Hospital, Capital Medical University, Beijing, China
| | - Lixia Yang
- Department of Cardiology, Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yujie Zhou
- Department of Cardiology, Anzhen Hospital, Capital Medical University, Beijing, China
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Rydén L, Grant PJ, Anker SD, Berne C, Cosentino F, Danchin N, Deaton C, Escaned J, Hammes HP, Huikuri H, Marre M, Marx N, Mellbin L, Ostergren J, Patrono C, Seferovic P, Uva MS, Taskinen MR, Tendera M, Tuomilehto J, Valensi P, Zamorano JL. ESC guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD - summary. Diab Vasc Dis Res 2014; 11:133-73. [PMID: 24800783 DOI: 10.1177/1479164114525548] [Citation(s) in RCA: 146] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
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Impact of chronic kidney disease on platelet reactivity and outcomes of patients receiving clopidogrel and undergoing percutaneous coronary intervention. Am J Cardiol 2014; 113:1124-9. [PMID: 24507863 DOI: 10.1016/j.amjcard.2013.12.018] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Revised: 12/16/2013] [Accepted: 12/16/2013] [Indexed: 01/09/2023]
Abstract
The impact of chronic kidney disease (CKD) on residual platelet reactivity (PR) in patients undergoing percutaneous coronary intervention (PCI) is still debatable. We sought to investigate the interaction between PR and renal function and the related clinical outcomes in patients with coronary artery disease treated with PCI. Immediately before PCI, we measured PR (as P2Y12 reaction units [PRUs]) in 800 patients on clopidogrel with the VerifyNow P2Y12 assay. High PR was defined as a PRU value of ≥240 and low PR as a PRU value of ≤178. Based on a glomerular filtration rate of < or ≥60 ml/min/1.73 m2, patients were respectively grouped into those with or without moderate-to-severe CKD. Primary end point was the incidence of 30-day net adverse clinical events (NACEs). Patients with moderate-to-severe CKD (n=173, 21.6%) and those without showed similar PRU values (208±67 vs 207±75, p=0.819). Yet, NACEs were significantly higher in patients with moderate-to-severe CKD (19.7% vs 9.1%, p<0.001), in terms of both ischemic (12.1% vs 7.2%, p=0.036) and bleeding events (8.7% vs 2.1%, p<0.001). NACEs were significantly higher when moderate-to-severe CKD was associated with either high PR or low PR (25.4%, p for trend<0.001); this association was the strongest predictor of NACE at multivariate analysis (odds ratio 3.4, 95% confidence interval 2.0 to 5.6, p<0.001). In conclusion, we did not find an association between moderate-to-severe CKD and residual PR on clopidogrel. However, the association of moderate-to-severe CKD with either high or low PR was a strong determinant of adverse events after PCI.
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Guía de práctica clínica de la ESC sobre diabetes, prediabetes y enfermedad cardiovascular, en colaboración con la European Association for the Study of Diabetes. Rev Esp Cardiol 2014. [DOI: 10.1016/j.recesp.2013.10.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Rydén L, Grant PJ, Anker SD, Berne C, Cosentino F, Danchin N, Deaton C, Escaned J, Hammes HP, Huikuri H, Marre M, Marx N, Mellbin L, Ostergren J, Patrono C, Seferovic P, Uva MS, Taskinen MR, Tendera M, Tuomilehto J, Valensi P, Zamorano JL, Zamorano JL, Achenbach S, Baumgartner H, Bax JJ, Bueno H, Dean V, Deaton C, Erol C, Fagard R, Ferrari R, Hasdai D, Hoes AW, Kirchhof P, Knuuti J, Kolh P, Lancellotti P, Linhart A, Nihoyannopoulos P, Piepoli MF, Ponikowski P, Sirnes PA, Tamargo JL, Tendera M, Torbicki A, Wijns W, Windecker S, De Backer G, Sirnes PA, Ezquerra EA, Avogaro A, Badimon L, Baranova E, Baumgartner H, Betteridge J, Ceriello A, Fagard R, Funck-Brentano C, Gulba DC, Hasdai D, Hoes AW, Kjekshus JK, Knuuti J, Kolh P, Lev E, Mueller C, Neyses L, Nilsson PM, Perk J, Ponikowski P, Reiner Z, Sattar N, Schächinger V, Scheen A, Schirmer H, Strömberg A, Sudzhaeva S, Tamargo JL, Viigimaa M, Vlachopoulos C, Xuereb RG. ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD: the Task Force on diabetes, pre-diabetes, and cardiovascular diseases of the European Society of Cardiology (ESC) and developed in collaboration with the European Association for the Study of Diabetes (EASD). Eur Heart J 2013; 34:3035-87. [PMID: 23996285 DOI: 10.1093/eurheartj/eht108] [Citation(s) in RCA: 1394] [Impact Index Per Article: 126.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
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- The disclosure forms of the authors and reviewers are available on the ESC website www.escardio.org/guidelines
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Abstract
Chronic kidney disease (CKD) significantly increases cardiovascular morbidity and mortality. CKD remains an under-represented population in cardiovascular clinical trials, and cardiovascular disease is an under-treated entity in CKD. Traditional cardiovascular risk factors in conjunction with uremia-related complications often progress to myocardial dysfunction. Such uremic cardiomyopathy leads to over-activation of neurohormonal pathways with detrimental effects. Management of the reno-cardiac syndrome (RCS) requires the targeting of these multiple facets. In this article we discuss the relevant pathophysiology of RCS, and present the clinical data related to its management.
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Affiliation(s)
- Nael Hawwa
- Medicine Institute, 9500 Euclid Avenue, Desk J3-4, Cleveland, OH 44195, USA
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