Platelet Effects of Anti-diabetic Therapies: New Perspectives in the Management of Patients with Diabetes and Cardiovascular Disease

Nusca, Annunziata; Tuccinardi, Dario; Pieralice, Silvia; Giannone, Sara; Carpenito, Myriam; Monte, Lavinia De; Watanabe, Mikiko; Cavallari, Ilaria; Maddaloni, Ernesto; Ussia, Gian Paolo; Manfrini, Silvia; Grigioni, Francesco

doi:10.3389/fphar.2021.670155

Cited by 34 publications

(30 citation statements)

References 164 publications

(230 reference statements)

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“…Accordingly, DPP-4 inhibitors eluting stents improved neointima regeneration in vitro and in a diabetic rabbit model [ 91 ]. These agents might also reduce PCI-related late complications through well-known anti-platelet properties [ 92 ]. Nevertheless, despite these favorable findings, clinical data available so far are conflicting.…”

Section: Prevention and Treatment Of Neo-atherosclerosismentioning

confidence: 99%

In Stent Neo-Atherosclerosis: Pathophysiology, Clinical Implications, Prevention, and Therapeutic Approaches

Nusca

Viscusi

Piccirillo

et al. 2022

Life

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Despite the dramatic improvements of revascularization therapies occurring in the past decades, a relevant percentage of patients treated with percutaneous coronary intervention (PCI) still develops stent failure due to neo-atherosclerosis (NA). This histopathological phenomenon following stent implantation represents the substrate for late in-stent restenosis (ISR) and late stent thrombosis (ST), with a significant impact on patient’s long-term clinical outcomes. This appears even more remarkable in the setting of drug-eluting stent implantation, where the substantial delay in vascular healing because of the released anti-proliferative agents might increase the occurrence of this complication. Since the underlying pathophysiological mechanisms of NA diverge from native atherosclerosis and early ISR, intra-coronary imaging techniques are crucial for its early detection, providing a proper in vivo assessment of both neo-intimal plaque composition and peri-strut structures. Furthermore, different strategies for NA prevention and treatment have been proposed, including tailored pharmacological therapies as well as specific invasive tools. Considering the increasing population undergoing PCI with drug-eluting stents (DES), this review aims to provide an updated overview of the most recent evidence regarding NA, discussing pathophysiology, contemporary intravascular imaging techniques, and well-established and experimental invasive and pharmacological treatment strategies.

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Section: Prevention and Treatment Of Neo-atherosclerosismentioning

confidence: 99%

In Stent Neo-Atherosclerosis: Pathophysiology, Clinical Implications, Prevention, and Therapeutic Approaches

Nusca

Viscusi

Piccirillo

et al. 2022

Life

Self Cite

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“…Multifactorial interventions involving anti‐diabetic medications especially the new agents such as GLP‐1 RAs, DPP‐4 inhibitors and SGLT2 inhibitors along with lifestyle changes may be a useful preventive strategy in reducing the risk of cardiovascular events including stroke. Furthermore, antiplatelet, or antithrombotic, agents are also useful in primary and secondary prevention of CVD in diabetes 220 …”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, antiplatelet, or antithrombotic, agents are also useful in primary and secondary prevention of CVD in diabetes. 220 On another tangent, insulin-requiring diabetes patients are at increased risk of stroke. 221 Moreover, insulin exposure is associated with higher cardiovascular mortality in diabetes.…”

Section: Subacute Phase (Continuous Bgl Monitoring)mentioning

confidence: 99%

Role of diabetes in stroke: Recent advances in pathophysiology and clinical management

Bradley

Spring

Beran

et al. 2021

Diabetes Metabolism Res

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The increasing prevalence of diabetes and stroke is a major global public health concern. Specifically, acute stroke patients, with pre-existing diabetes, pose a clinical challenge. It is established that diabetes is associated with a worse prognosis after acute stroke and the various biological factors that mediate poor recovery profiles in diabetic patients is unknown. The level of association and impact of diabetes, in the setting of reperfusion therapy, is yet to be determined. This article presents a comprehensive overview of the current knowledge of the role of diabetes in stroke, therapeutic strategies for primary and secondary prevention of cardiovascular disease and/or stroke in diabetes, and various therapeutic considerations that may apply during pre-stroke, acute, sub-acute and post-stroke stages. The early diagnosis of diabetes as a comorbidity for stroke, as well as tailored post-stroke management of diabetes, is pivotal to our efforts to limit the burden. Increasing awareness and involvement of neurologists in the management of diabetes and other cardiovascular risk factors is desirable towards improving stroke prevention and efficacy of reperfusion therapy in acute stroke patients with diabetes.

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“…Moreover, a reduction of mortality in critical AMI patients with DM may be achieved through cardio-and renal-protective therapies (7). Recently, sodium-glucose cotransporter 2 inhibitors (SGLT2i) were shown to provide cardiovascular protection and prevent renal function deterioration, moreover, SGLT2i can also inhibit platelet activation and may act synergistically with anti-platelet therapies in the setting of acute myocardial infarction (30)(31)(32), and could be of clinical benefit to this vulnerable population. Further research is needed on the development of novel interventions to reduce mortality and improve survival quality in critical AMI patients with DM.…”

Section: Discussionmentioning

confidence: 99%

Does Diabetes Mellitus Increase the Short- and Long-Term Mortality in Patients With Critical Acute Myocardial Infarction? Results From American MIMIC-III and Chinese CIN Cohorts

et al. 2021

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BackgroundThe harmful effect of diabetes mellitus (DM) on mortality in patients with acute myocardial infarction (AMI) remains controversial. Furthermore, few studies focused on critical AMI patients. We aimed to address whether DM increases short- and long-term mortality in this specific population.MethodsWe analyzed AMI patients admitted into coronary care unit (CCU) with follow-up of ≥1 year from two cohorts (MIMIC-III, Medical Information Mart for Intensive Care III; CIN, Cardiorenal ImprovemeNt Registry) in the United States and China. Main outcome was mortality at 30-day and 1-year following hospitalization. Kaplan-Meier curves and Cox proportional hazards models were constructed to examine the impact of DM on mortality in critical AMI patients.Results1774 critical AMI patients (mean age 69.3 ± 14.3 years, 46.1% had DM) were included from MIMIC-III and 3380 from the CIN cohort (mean age 62.2 ± 12.2 years, 29.3% had DM). In both cohorts, DM group was older and more prevalent in cardio-renal dysfunction than non-DM group. Controlling for confounders, DM group has a significantly higher 30-day mortality (adjusted odds ratio (aOR) (95% CI): 2.71 (1.99-3.73) in MIMIC-III; aOR (95% CI): 9.89 (5.81-17.87) in CIN), and increased 1-year mortality (adjusted hazard ratio (aHR) (95% CI): 1.91 (1.56-2.35) in MIMIC-III; aHR (95% CI): 2.62(1.99-3.45) in CIN) than non-DM group.ConclusionsTaking into account cardio-renal function, critical AMI patients with DM have a higher 30-day mortality and 1-year mortality than non-DM group in both cohorts. Further studies on prevention and management strategies for DM are needed for this population.Clinical Trial Registrationclinicaltrials.gov, NCT04407936.

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Platelet Effects of Anti-diabetic Therapies: New Perspectives in the Management of Patients with Diabetes and Cardiovascular Disease

Cited by 34 publications

References 164 publications

In Stent Neo-Atherosclerosis: Pathophysiology, Clinical Implications, Prevention, and Therapeutic Approaches

In Stent Neo-Atherosclerosis: Pathophysiology, Clinical Implications, Prevention, and Therapeutic Approaches

Role of diabetes in stroke: Recent advances in pathophysiology and clinical management

Does Diabetes Mellitus Increase the Short- and Long-Term Mortality in Patients With Critical Acute Myocardial Infarction? Results From American MIMIC-III and Chinese CIN Cohorts

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