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Prognostic Significance of Plasma Insulin Level for Deep Venous Thrombosis in Patients with Severe Traumatic Brain Injury in Critical Care. Neurocrit Care 2022; 38:263-278. [PMID: 36114315 DOI: 10.1007/s12028-022-01588-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 08/10/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND Whether insulin resistance underlies deep venous thrombosis (DVT) development in patients with severe traumatic brain injury (TBI) is unclear. In this study, the association between plasma insulin levels and DVT was analyzed in patients with severe TBI. METHODS A prospective observational study of 73 patients measured insulin, glucose, glucagon-like peptide 1 (GLP-1), inflammatory factors, and hematological profiles within four preset times during the first 14 days after TBI. Ultrasonic surveillance of DVT was tracked. Two-way analysis of variance was used to determine the factors that discriminated between patients with and without DVT or with and without insulin therapy. Partial correlations of insulin level with all the variables were conducted separately in patients with DVT or patients without DVT. Factors associated with DVT were analyzed by multivariable logistic regression. Neurological outcomes 6 months after TBI were assessed. RESULTS Among patients with a mean (± standard deviation) age of 53 (± 16 years), DVT developed in 20 patients (27%) on median 10.4 days (range 4-22), with higher Acute Physiology and Chronic Health Evaluation II scores but similar Sequential Organ Failure Assessment scores and TBI severity. Patients with DVT were more likely to receive insulin therapy than patients without DVT (60% vs. 28%; P = 0.012); hence, they had higher 14-day insulin levels. However, insulin levels were comparable between patients with DVT and patients without DVT in the subgroups of patients with insulin therapy (n = 27) and patients without insulin therapy (n = 46). The platelet profile significantly discriminated between patients with and without DVT. Surprisingly, none of the coagulation profiles, blood cell counts, or inflammatory mediators differed between the two groups. Patients with insulin therapy had significantly higher insulin (P = 0.006), glucose (P < 0.001), and GLP-1 (P = 0.01) levels and were more likely to develop DVT (60% vs. 15%; P < 0.001) along with concomitant platelet depletion. Insulin levels correlated with glucose, GLP-1 levels, and platelet count exclusively in patients without DVT. Conversely, in patients with DVT, insulin correlated negatively with GLP-1 levels (P = 0.016). Age (P = 0.01) and elevated insulin levels at days 4-7 (P = 0.04) were independently associated with DVT. Patients with insulin therapy also showed worse Glasgow Outcome Scale scores (P = 0.001). CONCLUSIONS Elevated insulin levels in the first 14 days after TBI may indicate insulin resistance, which is associated with platelet hyperactivity, and thus increasing the risk of DVT.
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Şaylık F, Akbulut T. Temporal relationship between serum calcium and triglyceride-glucose index and its impact on the incident of the acute coronary syndrome: a cross-lagged panel study. Acta Cardiol 2022:1-8. [PMID: 35969239 DOI: 10.1080/00015385.2022.2106017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Serum calcium (Ca) and insulin resistance (IR) can have impact on each other and both are associated with the acute coronary syndrome (ACS). The triglyceride-glucose (TyG) index is a surrogate marker of IR that can be easily calculated from fasting glucose and fasting triglyceride. AIM We aimed to investigate the temporal relationship between serum Ca and the TyG index and its impact on ACS development. METHODS We retrospectively collected 2856 eligible patients in this longitudinal observational study. Patients' basal characteristics and laboratory values, including serum Ca and TyG index, were noted at baseline and after a median 4-year (3-6 years) follow-up period at two different times. Cross-lagged panel analysis was performed to demonstrate the temporal relationship between serum Ca and the TyG index. The incidence of ACS was noted, and mediation analysis was used to detect the mediation effect of variables on the ACS. RESULTS Baseline serum Ca and TyG index were associated with follow-up serum Ca and TyG index. The path coefficient from baseline serum Ca to the follow-up TyG index was significantly different from the baseline TyG index to the follow-up serum Ca, which indicated a reciprocal temporal relationship. The TyG index had a mediation effect of 23.5% on the serum Ca-ACS association in the total population. CONCLUSION There was a reciprocal temporal relationship between serum Ca and the TyG index, and both were associated with the risk of incident ACS. The TyG index mediation effect on the association of serum Ca with ACS was 23.5%.
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Affiliation(s)
- Faysal Şaylık
- Department of Cardiology, Van Training and Research Hospital, Van, Turkey
| | - Tayyar Akbulut
- Department of Cardiology, Van Training and Research Hospital, Van, Turkey
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3
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Vecchié A, Montecucco F, Carbone F, Dallegri F, Bonaventura A. Diabetes and Vascular Disease: Is It All About Glycemia? Curr Pharm Des 2020; 25:3112-3127. [PMID: 31470783 DOI: 10.2174/1381612825666190830181944] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 08/24/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Diabetes is increasing over time, mainly driven by obesity, aging, and urbanization. Classical macro- and microvascular complications represent the final result of a complex interplay involving atherosclerosis at all stages. METHODS In this review, we aim at focusing on current updates in the pathophysiology of vascular disease in diabetes and discussing how new therapies might influence the management of these patients at high cardiovascular risk. Diabetes shows accelerated atherosclerosis with a larger inflammatory cell infiltrate, thus favoring the development of heart failure. 'Diabetic cardiomyopathy' perfectly describes a specific ischemia- and hypertension- independent entity due to diabetes-related metabolic alterations on myocardial function. Moreover, platelets from subjects with diabetes display a typical hyperreactivity explaining the stronger adhesion, activation, and aggregation. Additionally, diabetes provokes an exaggerated stimulation of the endothelium, with an increased release of reactive oxygen species and a reduced release of nitric oxide, both key elements of the endothelial dysfunction. Also, the coagulation cascade and leukocytes activate contributing to this pro-thrombotic environment. Neutrophils have been recently recognized to play a pivotal role by releasing neutrophil extracellular traps. Finally, microparticles from platelets, neutrophils or monocytes are detrimental effectors on the vessel wall and are involved both in vascular dysfunction and in thrombotic complications. CONCLUSION In light of these findings, the therapeutic management of diabetes needs to be mostly focused on limiting the progression of complications by targeting precise pathophysiological mechanisms rather than the mere glycemic control, which failed to markedly reduce the risk for macrovascular complications and mortality.
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Affiliation(s)
- Alessandra Vecchié
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, 6 viale Benedetto XV, 16132 Genoa, Italy.,Virginia Commonwealth University, Pauley Heart Center, Division of Cardiology, Department of Internal Medicine, Richmond, Virginia, United States of America
| | - Fabrizio Montecucco
- First Clinic of Internal Medicine, Department of Internal Medicine and Centre of Excellence for Biomedical Research (CEBR), University of Genoa, 6 Viale Benedetto XV, 16132 Genoa, Italy.,IRCCS Ospedale Policlinico San Martino Genova - Italian Cardiovascular Network, 10 Largo Benzi, 16132 Genoa, Italy
| | - Federico Carbone
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, 6 viale Benedetto XV, 16132 Genoa, Italy.,IRCCS Ospedale Policlinico San Martino Genova - Italian Cardiovascular Network, 10 Largo Benzi, 16132 Genoa, Italy
| | - Franco Dallegri
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, 6 viale Benedetto XV, 16132 Genoa, Italy.,IRCCS Ospedale Policlinico San Martino Genova - Italian Cardiovascular Network, 10 Largo Benzi, 16132 Genoa, Italy
| | - Aldo Bonaventura
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, 6 viale Benedetto XV, 16132 Genoa, Italy.,Virginia Commonwealth University, Pauley Heart Center, Division of Cardiology, Department of Internal Medicine, Richmond, Virginia, United States of America
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4
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Wu X, Han T, Gao J, Zhang Y, Zhao S, Sun R, Sun C, Niu Y, Li Y. Association of Serum Calcium and Insulin Resistance With Hypertension Risk: A Prospective Population-Based Study. J Am Heart Assoc 2020; 8:e009585. [PMID: 30596304 PMCID: PMC6405709 DOI: 10.1161/jaha.118.009585] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background The temporal sequence between serum calcium and insulin resistance (IR) and their effects on hypertension are unclear. We studied the association between serum calcium and IR, with risk of hypertension events in a longitudinal cohort conducted in China. Methods and Results Data from 8653 subjects aged 20 to 74 years with an average follow‐up of 5.3 years were analyzed. Serum calcium, and fasting and 2‐hour serum glucose and insulin were measured at baseline and follow‐up. Cross‐lagged panel and mediation analysis were used to examine the temporal relationship between serum calcium and IR and its impact on hypertension incidence. The conjoint effects of serum calcium and IR at baseline on hypertension at follow‐up were observed (P=0.029 for HOMA_IR [hepatic IR] and P=0.009 for Gutt index [peripheral IR]). The cross‐lagged path coefficient (β2) from baseline serum calcium to follow‐up peripheral IR were significantly greater than path coefficient (β1) from baseline peripheral insulin resistance to follow‐up serum calcium (β2 =−0.354 versus β1=−0.005; P=0.027). However, no directional relationships were observed in the serum calcium↔hepatic IR analysis. The mediation effect of peripheral IR on the association of serum calcium at baseline with hypertension at follow‐up was estimated at 16.4% (P<0.001). Conclusions Our findings demonstrate that higher serum calcium levels probably precede peripheral IR, and this 1‐directional relation plays a role in the development of hypertension.
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Affiliation(s)
- Xiaoyan Wu
- 1 Department of Nutrition and Food Hygiene the National Key Discipline School of Public Health Harbin Medical University Harbin P. R. China
| | - Tianshu Han
- 1 Department of Nutrition and Food Hygiene the National Key Discipline School of Public Health Harbin Medical University Harbin P. R. China
| | - Jian Gao
- 1 Department of Nutrition and Food Hygiene the National Key Discipline School of Public Health Harbin Medical University Harbin P. R. China
| | - Yunlong Zhang
- 1 Department of Nutrition and Food Hygiene the National Key Discipline School of Public Health Harbin Medical University Harbin P. R. China
| | - Shengnan Zhao
- 1 Department of Nutrition and Food Hygiene the National Key Discipline School of Public Health Harbin Medical University Harbin P. R. China
| | - Rongbo Sun
- 1 Department of Nutrition and Food Hygiene the National Key Discipline School of Public Health Harbin Medical University Harbin P. R. China
| | - Changhao Sun
- 1 Department of Nutrition and Food Hygiene the National Key Discipline School of Public Health Harbin Medical University Harbin P. R. China
| | - Yucun Niu
- 1 Department of Nutrition and Food Hygiene the National Key Discipline School of Public Health Harbin Medical University Harbin P. R. China
| | - Ying Li
- 1 Department of Nutrition and Food Hygiene the National Key Discipline School of Public Health Harbin Medical University Harbin P. R. China
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5
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Bonaventura A, Liberale L, Montecucco F. Aspirin in primary prevention for patients with diabetes: Still a matter of debate. Eur J Clin Invest 2018; 48:e13001. [PMID: 30011059 DOI: 10.1111/eci.13001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 07/15/2018] [Indexed: 12/25/2022]
Abstract
BACKGROUND Patients with diabetes are at high cardiovascular (CV) risk due to an exaggerated platelet activation and aggregation. In the first 2000s low-dose aspirin was first recommended for primary prevention, but then re-discussed. METHODS This short narrative review, based on the material searched for and obtained via PubMed up to February 2018, aims at clarifying this controversial topic. RESULTS The JPAD2 study has been designed to evaluate the occurrence of any CV event in a cohort of patients with diabetes and concluded that low-dose aspirin did not influence the risk for CV events while increasing the risk for gastrointestinal (GI) bleeding. Reasons for this result can be found in the role of diabetic platelets, which are known to be hyperreactive, thus producing intensified adhesion, activation, and aggregation. In this setting, other associated metabolic conditions can concur to enhance platelet adhesion and activation. Aspirin resistance has been often considered a guilty actor, although many mechanisms have been mistaken for true aspirin resistance, such as patient poor compliance, inadequate dosing, drug interactions, and high-platelet turnover. However, the mere presence of diabetes is not likely to give a net benefit for CV protection with respect to GI bleeding. CONCLUSION It appears advisable to follow current guidelines addressing first of all classical risk factors and evaluate aspirin therapy in primary prevention only for patients with type 1 or 2 diabetes at increased CV risk and no risk for GI bleeding. Anyway, additional clinical trials are needed to address the current topic.
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Affiliation(s)
- Aldo Bonaventura
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Luca Liberale
- Center for Molecular Cardiology, University of Zurich, Zurich, Switzerland
| | - Fabrizio Montecucco
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, Genoa, Italy.,Ospedale Policlinico San Martino, Genoa, Italy.,Centre of Excellence for Biomedical Research (CEBR), University of Genoa, Genoa, Italy
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6
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Rivas Rios JR, Franchi F, Rollini F, Angiolillo DJ. Diabetes and antiplatelet therapy: from bench to bedside. Cardiovasc Diagn Ther 2018; 8:594-609. [PMID: 30498684 DOI: 10.21037/cdt.2018.05.09] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Diabetes mellitus (DM) is a metabolic disorder associated with accelerated atherogenesis and an increased risk of atherothrombotic complications. Multiple mechanisms contribute to the pro-thrombotic status which characterizes DM patients underscoring the importance of antiplatelet therapies used for secondary prevention in these patients. For many years, dual antiplatelet therapy (DAPT) with aspirin and the P2Y12 inhibitor clopidogrel has represented the mainstay of treatment following an acute coronary syndrome (ACS) or in patients undergoing percutaneous coronary interventions (PCI). Although DAPT reduces the incidence of atherothrombotic recurrences, these rates remain high in DM patients underscoring the need for more efficacious therapies. Oral platelet P2Y12 receptor inhibitors with enhanced potency, such as prasugrel and ticagrelor, as well as antiplatelet therapies such as vorapaxar inhibiting the thrombin-mediated platelet signaling pathway, constitute treatment opportunities for patients with DM and have shown to be associated with a greater reduction in ischemic recurrences, albeit at the cost of more bleeding. This article reviews currently available antiplatelet agents and delivers an update on the advances and drawbacks of these agents used for secondary prevention in DM patients experiencing an ACS or undergoing PCI.
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Affiliation(s)
- Jose R Rivas Rios
- Division of Cardiology, University of Florida College of Medicine-Jacksonville, Jacksonville, Florida, USA
| | - Francesco Franchi
- Division of Cardiology, University of Florida College of Medicine-Jacksonville, Jacksonville, Florida, USA
| | - Fabiana Rollini
- Division of Cardiology, University of Florida College of Medicine-Jacksonville, Jacksonville, Florida, USA
| | - Dominick J Angiolillo
- Division of Cardiology, University of Florida College of Medicine-Jacksonville, Jacksonville, Florida, USA
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7
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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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8
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Moschonas IC, Tselepis AD. Increased Benefit With Vorapaxar Use in Patients With a History of Myocardial Infarction and Diabetes Mellitus: What the Data Show Us. J Cardiovasc Pharmacol Ther 2016; 22:133-141. [PMID: 27489245 DOI: 10.1177/1074248416662347] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Type 2 diabetes mellitus (T2DM) is a progressive and multifactorial metabolic disease mainly characterized by hyperglycemia and insulin resistance. Abnormal platelet reactivity associated with an increased risk of cardiovascular disease (CVD) is also a feature characteristic of patients with T2DM. Dual antiplatelet therapy consisting of aspirin and an adenosine diphosphate platelet P2Y12 receptor antagonist, such as clopidogrel, represents the standard antithrombotic regimen for the secondary prevention of CVD risk in T2DM. However, a high proportion of patients with T2DM exhibit high on-treatment platelet reactivity to aspirin and/or clopidogrel, associated with a greater risk of adverse cardiovascular events compared with nondiabetic patients. Consequently, novel antiplatelet therapeutic approaches may be required in order to avoid such events. Vorapaxar is a novel antiplatelet agent that targets the platelet protease-activated receptor 1 and inhibits thrombin-induced platelet activation. Vorapaxar has been studied in 2 phase III clinical trials and has been approved for use in the secondary prevention of atherothrombotic events in patients with a previous myocardial infarction (MI) or peripheral arterial disease. New data from the Thrombin-Receptor Antagonist in Secondary Prevention of Atherothrombotic Ischemic Events (TRA 2°P)-TIMI 50 trial MI cohort demonstrate that the subgroup of patients with T2DM exhibits increased benefit from vorapaxar use compared with non-T2DM patients. The aim of the present work is to critically review the current knowledge concerning vorapaxar use in patients with T2DM as well as to discuss the possible mechanism(s) underlying vorapaxar's beneficial effect in T2DM.
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Affiliation(s)
- Iraklis C Moschonas
- 1 Atherothrombosis Research Centre/Laboratory of Biochemistry, Department of Chemistry, University of Ioannina, Ioannina, Greece
| | - Alexandros D Tselepis
- 1 Atherothrombosis Research Centre/Laboratory of Biochemistry, Department of Chemistry, University of Ioannina, Ioannina, Greece
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9
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Proscia C, Nusca A, Simona M, Rosetta M, Di Sciascio G. Platelet reactivity and antiplatelet management in diabetic patients with coronary artery disease. Interv Cardiol 2015. [DOI: 10.2217/ica.15.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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10
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Kumbhani DJ, Marso SP, Alvarez CA, McGuire DK. State-of-the-Art: Hypo-responsiveness to oral antiplatelet therapy in patients with type 2 diabetes mellitus. CURRENT CARDIOVASCULAR RISK REPORTS 2015; 9:4. [PMID: 25844111 DOI: 10.1007/s12170-014-0430-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Diabetes mellitus is a global pandemic, associated with a high burden of cardiovascular disease. There are multiple platelet derangements in patients with diabetes, and antiplatelet drugs remain the first-line agents for secondary prevention as well as for high-risk primary prevention among patients with diabetes. This review provides a summary of oral antiplatelet drug hypo-responsiveness in patients with diabetes, specifically aspirin and Clopidogrel resistance. Topics discussed include antiplatelet testing, definitions used to define hypo-response and resistance, its prevalence, association with clinical outcomes and strategies to mitigate resistance. The role of prasugrel and ticagrelor, as well as investigational agents, is also discussed.
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Affiliation(s)
- Dharam J Kumbhani
- UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390-9047, /
| | - Steven P Marso
- UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390-, /
| | - Carlos A Alvarez
- Texas Tech University Health Sciences Center, 5920 Forest Park Road, Dallas, TX 75235, /
| | - Darren K McGuire
- UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390-8830, /
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11
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Personalized antiplatelet therapy with P2Y12 receptor inhibitors: benefits and pitfalls. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2015; 11:259-80. [PMID: 26677375 PMCID: PMC4679793 DOI: 10.5114/pwki.2015.55596] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Revised: 11/05/2015] [Accepted: 11/05/2015] [Indexed: 02/07/2023] Open
Abstract
Antiplatelet therapy with P2Y12 receptor inhibitors has become the cornerstone of medical treatment in patients with acute coronary syndrome, after percutaneous coronary intervention and in secondary prevention of atherothrombotic events. Clopidogrel used to be the most broadly prescribed P2Y12 receptor inhibitor with undisputable benefits especially in combination with aspirin, but a considerable number of clopidogrel-treated patients experience adverse thrombotic events in whom insufficient P2Y12-inhibition and a consequential high on-treatment platelet reactivity is a common finding. This clinically relevant limitation of clopidogrel has driven the increased use of new antiplatelet agents. Prasugrel (a third generation thienopyridine) and ticagrelor (a cyclopentyl-triazolo-pyrimidine) feature more potent and predictable P2Y12-inhibition compared to clopidogrel, which translates into improved ischemic outcomes. However, excessive platelet inhibition and consequential low on-treatment platelet reactivity comes at the price of increased risk of major bleeding. The majority of randomized clinical trials failed to demonstrate improved clinical outcomes with platelet function testing and tailored antiplatelet therapy, but results of all recent trials of potent antiplatelets and prolonged antiplatelet durations point towards a need for individualized antiplatelet approach in order to decrease thrombotic events without increasing bleeding. This review focuses on potential strategies for personalizing antiplatelet treatment.
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12
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Patti G, Proscia C, Di Sciascio G. Antiplatelet Therapy in Patients With Diabetes Mellitus and Acute Coronary Syndrome. Circ J 2014; 78:33-41. [DOI: 10.1253/circj.cj-13-0742] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Giuseppe Patti
- Department of Cardiovascular Sciences, Campus Bio-Medico University of Rome
| | - Claudio Proscia
- Department of Cardiovascular Sciences, Campus Bio-Medico University of Rome
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13
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Rollini F, Franchi F, Muñiz-Lozano A, Angiolillo DJ. Platelet function profiles in patients with diabetes mellitus. J Cardiovasc Transl Res 2013; 6:329-45. [PMID: 23404189 DOI: 10.1007/s12265-013-9449-0] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Accepted: 01/25/2013] [Indexed: 12/22/2022]
Abstract
Patients with diabetes mellitus (DM) are at high risk for several cardiovascular disorders such as coronary heart disease, stroke, peripheral arterial disease, and congestive heart failure. DM has reached epidemic proportions and its strong association with coronary artery disease is responsible for increased cardiovascular morbidity and mortality. DM patients are characterized by platelet hyperreactivity, which contribute to the enhanced atherothrombotic risk of these subjects. Several mechanisms are involved in the hyperreactive platelet phenotype characterizing DM patients. Furthermore, a large proportion of DM patients show inadequate response to standard antiplatelet treatments and high rate of adverse recurrent cardiovascular events despite compliance with standard antiplatelet treatment regimens. Therefore, new antiplatelet treatment regimens are warranted in DM patients to reduce their atherothrombotic risk. The present manuscript provides an overview on the current status of knowledge on platelet function profiles in patients with DM and therapeutic considerations.
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Affiliation(s)
- Fabiana Rollini
- University of Florida College of Medicine-Jacksonville, 655 West 8th Street, Jacksonville, FL 32209, USA
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14
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Diabetes mellitus and thrombosis. Thromb Res 2011; 129:371-7. [PMID: 22197180 DOI: 10.1016/j.thromres.2011.11.052] [Citation(s) in RCA: 157] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2011] [Revised: 11/29/2011] [Accepted: 11/30/2011] [Indexed: 02/06/2023]
Abstract
Atherothrombosis is the leading cause of morbidity and mortality in patients with diabetes mellitus. Several mechanisms contribute to the diabetic prothrombotic state, including endothelial dysfunction, coagulative activation and platelet hyper-reactivity. In particular, diabetic platelets are characterised by dysregulation of several signaling pathways leading to enhanced adhesion, activation and aggregation. These alterations result from the interaction among hyperglycemia, insulin resistance, inflammation and oxidative stress. This review will provide an overview of the current status of knowledge on mechanisms of accelerated atherothrombosis in patients with diabetes mellitus.
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15
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Kakouros N, Rade JJ, Kourliouros A, Resar JR. Platelet function in patients with diabetes mellitus: from a theoretical to a practical perspective. Int J Endocrinol 2011; 2011:742719. [PMID: 21869886 PMCID: PMC3159301 DOI: 10.1155/2011/742719] [Citation(s) in RCA: 109] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2011] [Accepted: 06/22/2011] [Indexed: 11/24/2022] Open
Abstract
Patients with diabetes mellitus have an increased prevalence of vascular disease. Pathologic thrombosis associated with atherosclerotic plaque rupture is a major cause of morbidity and mortality. Platelets are intimately involved in the initiation and propagation of thrombosis. Evidence suggests that platelets from patients with type 2 diabetes have increased reactivity and baseline activation compared to healthy controls. We review the pathophysiology of platelet hyperreactivity in DM patients and its implications in clinical practice, with particular focus on acute coronary syndromes, percutaneous coronary intervention, and novel antiplatelet agents.
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Affiliation(s)
- Nicholaos Kakouros
- Johns Hopkins University School of Medicine, and Johns Hopkins Hospital Division of Cardiovascular Disease, Baltimore, MD 21287-073, USA
- *Nicholaos Kakouros:
| | - Jeffrey J. Rade
- Johns Hopkins University School of Medicine, and Johns Hopkins Hospital Division of Cardiovascular Disease, Baltimore, MD 21287-073, USA
| | | | - Jon R. Resar
- Johns Hopkins University School of Medicine, and Johns Hopkins Hospital Division of Cardiovascular Disease, Baltimore, MD 21287-073, USA
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Abstract
Patients with diabetes mellitus (DM) have accelerated atherosclerosis, which is the main underlying factor contributing to the high risk of atherothrombotic events in these patients. Atherothrombotic complications are the leading cause of morbidity and mortality in patients with DM. Among factors contributing to the prothrombotic condition which characterise patients with DM, platelet hyperreactivity plays a pivotal role. Platelets of DM patients are characterised by dysregulation of several signalling pathways leading to intensified adhesion, activation and aggregation. Multiple mechanisms are involved in platelet dysfunction of patients with DM, which can be categorised as follows: a) hyperglycaemia, b) insulin deficiency and resistance, c) associated metabolic conditions, and d) other cellular abnormalities.The present manuscript aims to provide an overview on the current status of knowledge on platelet abnormalities that characterise patients with DM.
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Affiliation(s)
- José Luis Ferreiro
- IDIBELL-Hospital Universitari de Bellvitge, Department of Cardiology, Interventional Cardiology Unit, L'Hospitalet de Llobregat, Barcelona, Spain
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Randriamboavonjy V, Fleming I. The Role of Calpain in Diabetes-Associated Platelet Hyperactivation. CARDIOVASCULAR PHARMACOLOGY - HEART AND CIRCULATION 2010; 59:235-57. [DOI: 10.1016/s1054-3589(10)59008-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Affiliation(s)
| | - Ingrid Fleming
- From the Institute for Vascular Signalling, Johann Wolfgang Goethe University, Frankfurt am Main, Germany
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Atucha NM, Iyú D, Alcaraz A, Rosa V, Martínez-Prieto C, Ortiz MC, Rosado JA, García-Estañ J. Altered calcium signalling in platelets from bile-duct-ligated rats. Clin Sci (Lond) 2007; 112:167-74. [PMID: 16948638 DOI: 10.1042/cs20060226] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In the present study, we have analysed the mechanisms of Ca2+ entry and release in platelets obtained from BDL (bile-duct-ligated) rats, 11–13 days and 4 weeks after surgery. Platelets were washed and loaded with fura-2, and [Ca2+]i (cytosolic Ca2+ concentration) was determined in cell suspensions by means of fluorescence spectroscopy. Basal [Ca2+]i was similar in platelets from BDL rats compared with those from their respective controls, both in the absence and presence of extracellular Ca2+. Platelet stimulation with thrombin in the absence and presence of extracellular Ca2+ induced a rapid rise in [Ca2+]i that was of greater magnitude in platelets from BDL rats than in controls. Ca2+ storage was significantly elevated in platelets from BDL rats, as well as the activity of SERCA (sarcoplasmic/endoplasmic-reticulum Ca2+-ATPase). Capacitative Ca2+ entry, as evaluated by inhibition of SERCA with thapsigargin, was also altered in platelets from BDL rats, having lower rates of Ca2+ entry. In conclusion, chronic BDL alters intracellular Ca2+ homoeostasis in platelets, such that an enhanced Ca2+ release is evoked by thrombin, which may be due to an increased amount of Ca2+ stored in the intracellular organelles and secondary to an enhanced activity of SERCA. These alterations are already evident before cirrhosis has completely developed and occurs during the cholestasis phase.
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Affiliation(s)
- Noemí M Atucha
- Department of Physiology, Faculty of Medicine, University of Murcia, 30100 Murcia, Spain.
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20
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Abstract
The Diabetes Control and Complications Trial (DCCT) ended decades of controversy regarding the necessity of tight glycemic control for type 1 diabetes by demonstrating that glucose control using intensive insulin therapy significantly reduced long-term microvascular complications. The American Diabetes Association (ADA) guidelines empirically support the same goal of attempting to obtain normoglycemia in patients with type 2 disease; however, unlike in type 1 disease, insulin is a tertiary option, following diet, exercise, and oral agents. Emerging long-term intervention data in type 2 diabetes suggest that insulin may pose increased cardiovascular risk in this already 'at-risk' population. However, many type 2 diabetics will eventually require insulin. Clearly, more studies are warranted to assess the risks, benefits, and feasibility of improved glycemic control in type 2 diabetes. Nonetheless, two principles are clear. First, promoting blood glucose levels approaching normoglycemia is an important factor in preventing long-term microvascular complications. Second, type 2 diabetes comprises numerous metabolic conditions; therefore an integrated effort by the patient and healthcare team is required to optimize blood glucose and serum lipid levels and minimize cardiovascular risk factors.
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Affiliation(s)
- J G Barranco
- Department of Endocrinology, National Institute of Nutrition SZ, Vasco de Quiroga No. 15, Mexico City ZC 14000
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Ceolotto G, Pessina AC, Iori E, Monari A, Trevisan R, Winkleswski P, Semplicini A. Modulatory effect of insulin on release of calcium from human fibroblasts by angiotensin II. J Hypertens 1998; 16:487-93. [PMID: 9797194 DOI: 10.1097/00004872-199816040-00010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Angiotensin II stimulates synthesis and deposition of collagen and might contribute to the vascular and cardiac dysfunction associated with arterial hypertension. Insulin attenuates angiotensin II-induced responses of intracellular Ca2+ concentration ([Ca2+]) in many cell types but this effect is less in insulin-resistant states. The mechanisms of the interaction between insulin and angiotensin II are still not known. OBJECTIVE To characterize the effects of angiotensin II on intracellular [Ca2+] and the effects of insulin on the angiotensin II-induced response of intracellular [Ca2+] in human skin fibroblasts. METHODS Spectrofluorophotometric measurements of intracellular [Ca2+] in monolayers of cultured human skin fibroblasts from 15 normotensive patients were performed using Fura-2 at 510 nm emission with excitation wavelengths of 340 and 380 nm. RESULTS Basal intracellular [Ca2+] in quiescent (24 h serum-deprived) human fibroblasts was 75 +/- 3 nmol/l (n = 20). Administration of angiotensin II elevated intracellular [Ca2+] dose-dependently with a concentration for half-maximal effect of 20 nmol/l. Administration of 100 nmol/l angiotensin II stimulated a rapid and transient increase in intracellular [Ca2+] (from 75 +/- 3 to 130 +/- 2 nmol/l, n = 20). Removal of extracellular calcium did not change peak intracellular [Ca2+], but it did reduce the time to recovery of [Ca2+] (from 64 +/- 4 to 48 +/- 2 s, n = 10, P < 0.01), suggesting that an angiotensin II-induced transmembrane calcium influx had occurred. This hypothesis was confirmed by quenching studies with manganese. The angiotensin II-induced changes in intracellular [Ca2+] were completely blocked by administration of 100 nmol/l of the angiotensin II type 1 receptor inhibitor losartan but not by administration of 100 nmol/l of the angiotensin II type 2 receptor blocker CGP42112A. Acute (20 min) exposure to 100 nmol/l insulin did not alter basal intracellular [Ca2+] in quiescent fibroblasts, but significantly blunted angiotensin II-stimulated peak of [Ca2+] (to 101 +/- 3 nmol/l, P < 0.01, n = 18) and delayed recovery of [Ca2+] (to 99 +/- 5 s, P < 0.01). The inhibitory effect of insulin was observed both with and without extracellular Ca2+. CONCLUSIONS Our results demonstrate that administration of angiotensin II increases intracellular [Ca2+] in human skin fibroblasts by release of Ca2+ from intracellular Ca2+ stores and by influx of Ca2+ and that administration of insulin attenuates the response of [Ca2+] to angiotensin II but prolongs the time to recovery of [Ca2+].
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Affiliation(s)
- G Ceolotto
- Department of Clinical and Experimental Medicine, University of Padova Medical School, Italy
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