No Differences in Levels of Circulating Progenitor Endothelial Cells or Circulating Endothelial Cells Among Patients Treated With Ticagrelor Compared With Clopidogrel During Non–ST‐Segment–Elevation Myocardial Infarction

Abstract

Background Ticagrelor use during acute coronary syndromes demonstrated a decrease in all‐cause mortality in the PLATO (Platelet Inhibition and Patient Outcomes) trial. This effect has been attributed to a non–platelet‐derived improvement in endothelial function. The aim of this study was to determine differences in the number of endothelial progenitor cells and/or circulating endothelial cells found in peripheral blood in patients treated with either ticagrelor or clopidogrel during non–ST‐segment–elevation myocardial infarction. Methods and Results In this multicenter, randomized study ( NCT 02244710), patients were considered for inclusion after non–ST‐segment–elevation myocardial infarction whenever they were P2Y 12 ‐inhibitor naïve. Ticagrelor and clopidogrel were allocated at a 1:1 ratio. Blood samples for determining endothelial progenitor cells and circulating endothelial cells were extracted before the antiplatelet loading dose, 48 hours after presentation of index symptoms, and 1 month after the event. A multichannel cytometer was used for optimal cell characterization. A total of 96 patients fulfilled the inclusion criteria. Circulating endothelial cell levels corrected by white blood cells were as follows at baseline, 48 hours, and 1 month: 44 (28–64), 50 (33–63), and 38 (23–62) cells/mL, respectively, for clopidogrel and 38 (29–60), 45 (32–85), and 35 (24–71) cells/mL, respectively, for ticagrelor ( P =0.6). Endothelial progenitor cell levels were 29 (15–47), 27 (15–33), and 18 (10–25) cells/mL, respectively, for clopidogrel and 20 (11–33), 22 (12–32), and 18 (11–29) cells/mL, respectively, for ticagrelor ( P =0.9). No differences in intraindividual changes were found. Conclusions Patients treated with ticagrelor during non–ST‐segment–elevation myocardial infarction, in comparison to clopidogrel, showed similar levels of endothelial progenitor cells and circulating endothelial cells. These data suggest that the endothelial protective effect mediated by ticagrelor is not related to bone marrow physiology modulation. Clinical Trial Registration URL: https://www.clinicaltrials.gov . Unique identifier: NCT 02244710.

The Effect of Ticagrelor on Endothelial Function Compared to Prasugrel, Clopidogrel, and Placebo: A Systematic Review and Meta-Analysis

“…Several studies suggested that ticagrelor ameliorated endothelial dysfunction ( 8 – 11 ). In contrast, other studies demonstrated that ticagrelor conferred no additional beneficial effect on endothelial dysfunction ( 5 , 12 , 13 ).…”

“…Three studies analyzed CECs with 386 participants ( 13 , 31 , 32 ). A meta-analysis based on changes in ticagrelor and control groups indicated that ticagrelor did produce any significant effects on CEC levels (WMD: −1.08; 95% CI: −8.63, −6.47) ( Table 2 and Figure 6 ).…”

A precision medicine approach to sex-based differences in ideal cardiovascular health

“…Life’s Simple 7 utilizes these data to categorize cardiovascular health and behaviors as poor, intermediate, or ideal based on a set of predefined criteria 6 – 8 . Women and men had a similar distribution of participants that had poor, intermediate, or ideal scores for Life’s Simple 7 smoking status, physical activity, healthy weight, healthy diet, and cholesterol scores.…”

“…The American Heart Association has prioritized ideal cardiovascular health for all as a strategic impact goal to decrease cardiovascular mortality and increase health equity as well as overall health and well-being 6 , 7 . Ideal cardiovascular health has been defined by a composite of modifiable health factors (blood pressure, fasting blood sugar, cholesterol levels, healthy weight) and health behaviors (diet, exercise and activity, tobacco use) 8 . The relationship between ideal cardiovascular health and cardiovascular outcomes has been demonstrated.…”

Crosstalk between Circulatory Microenvironment and Vascular Endothelial Cells in Acute Myocardial Infarction

“…In recent years, the effect of peripheral blood circulation and 3 types intravascular cells and peripheral blood on AMI has become a research hotspot, [42][43][44] while their mechanism is still unclear. Therefore, it is particularly important to explore the interaction between 3 types of intravascular cells and peripheral blood for formulating therapeutic strategies.…”