Antithrombotic therapy and revascularisation strategies in people with diabetes and coronary artery disease

Abstract

Background Diabetes mellitus, largely type 2, affects nearly 10% of the global adult population according to the World Health Organization. Diabetes is an independent risk factor for atherosclerotic cardiovascular diseases, including coronary artery disease. Diabetes patients experience a two to three-fold increased incidence of coronary artery disease, despite improved metabolic control and management of other cardiovascular risk factors. Discussion Platelet abnormalities and activation as well as reduced antiplatelet drug responsiveness characterise diabetes mellitus. Mechanisms linking diabetes to platelet and vascular abnormalities, atherogenesis and atherosclerotic cardiovascular disease are still only partially known, highlighting the unique complexity of the pro-atherogenic clinical scenario and its treatment. Consistently, a higher residual cardiovascular risk characterises patients with diabetes compared with those without, in spite of improved antiplatelet and antithrombotic treatment combinations. Randomised clinical trials aimed at optimising antiplatelet treatment specifically in patients with diabetes are lacking, both in acute and chronic coronary artery disease settings. Thus, patients with diabetes are treated with regimens validated in studies including only variable proportions of diabetes patients. Myocardial revascularisation appears to confer a comparable relative benefit between diabetes patients and patients without diabetes, and generally coronary artery bypass grafting has a better outcome in diabetes mellitus versus peripheral coronary intervention. New glucose-lowering drugs have been shown to reduce the incidence of major cardiovascular events in secondary prevention. Type 1 diabetes mellitus remains less explored than type 2 in this context. Conclusion Diabetes-tailored antithrombotic strategies in acute and chronic coronary artery disease remain an unmet clinical need, requiring ad-hoc trials and precision pharmacological strategies.

High residual cardiovascular risk after lipid-lowering: prime time for Predictive, Preventive, Personalized, Participatory, and Psycho-cognitive medicine

“…Particularly after invasive procedures, dual antiplatelet therapy proved to be highly effective in preventing thrombotic events. Also, in diabetics anti-thrombotic strategies in acute and chronic CAD remain an unmet clinical need ( 134 ).…”

Can Aspirin Use Be Associated With the Risk or Prognosis of Bladder Cancer? A Case-Control Study and Meta-analytic Assessment

“…Interestingly, we found that aspirin intake (HR=3.876; P=0.019) and type of surgery (HR=1.685; P=0.010) were significantly associated with overall survival in BCa patients younger than 68 years old. In the people who regularly used aspirin, majority of them has the history of coagulation abnormalities, consisting of platelet abnormalities and fibrinolysis (78)(79)(80). And coagulation abnormalities have long been closely related with the cardiovascular or cerebrovascular diseases, which are mostly found in the elderly and increased overall mortality considerably (81,82).…”

<p>Activation of Nrf2 Signaling by Apelin Attenuates Renal Ischemia Reperfusion Injury in Diabetic Rats</p>

“…Type 1 diabetes is characterized by a complete or nearly complete insulin deficiency and type 2 diabetes, the most common type of diabetes, is characterized by insulin resistance and a dysfunction of insulin synthesis and release by pancreatic β-cells. 3,4 Increasing reports have illustrated that diabetes patients have a higher risk of cardiovascular diseases (CVDs), 5,6 which can, in turn, promote the progression and generate adverse outcomes. 7 Due to the original damage to renal blood flow, after I/R injury, hypoxia-sensitive renal tissue and cells produce excessive ROS in an explosive manner, resulting in cell DNA damage and apoptosis and necrosis of cells in renal tissue.…”