Aspirin in the prevention of cardiovascular events in patients with diabetes

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. ARTICLE HISTORY

Paeoniflorin ameliorates glycemic variability-induced oxidative stress and platelet activation in HUVECs and DM rats

“…Aspirin is a classic antiplatelet drug that reduces the risk of cardiovascular events in patients with diabetes through the irreversible inhibition of cyclooxygenase (COX)-1, a key enzyme involved in vascular clot formation. 38 In our study, we found increased platelet aggregation rate and high level of CD62p under GV in vitro and in vivo , respectively. Notably, the ability of PAE to alleviate platelet hyperaggregability induced by GV was similar to that of aspirin.…”

Clopidogrel Reduces Fibronectin Accumulation and Improves Diabetes-Induced Renal Fibrosis

“…However, no effective prevention of CV events by the administration of low-dose aspirin has been shown earlier, which might have been caused by the existence of resistance 11. Therefore, owing to its effectiveness in the prevention of CV events and improvement of the survival of diabetic patients, clopidogrel may be able to successfully replace aspirin as an attractive therapeutic option in this respect 11. Evidence revealed that clopidogrel treatment contributed to a greater improvement in the renal function and the inflammatory burden than that with aspirin 30, 31.…”

“…Therefore, low-dose aspirin has been recommended for primary and secondary prevention of CV events in diabetic patients 26. However, no effective prevention of CV events by the administration of low-dose aspirin has been shown earlier, which might have been caused by the existence of resistance 11. Therefore, owing to its effectiveness in the prevention of CV events and improvement of the survival of diabetic patients, clopidogrel may be able to successfully replace aspirin as an attractive therapeutic option in this respect 11.…”

“…Significant alterations of platelet function and their hyper activation in diabetic patients 9 have led to current medical guidelines recommendations of prophylactic treatment, such as once-daily administration of low-dose aspirin (acetylsalicylic acid) to decrease platelet activation and for primary and secondary prevention of cardiovascular (CV) events in high-risk diabetic patients 10. However, emerging clinical evidence indicates that aspirin does not prevent CV events in adult diabetic patients better than placebo 11. A recent study reported that administration of clopidogrel as an alternative to aspirin, decreased stroke recurrence and CV outcomes in patients with type 2 diabetes (T2D) 12.…”