Aspirin in primary prevention for patients with diabetes: Still a matter of debate

Bonaventura, Aldo; Liberale, Luca; Montecucco, Fabrizio

doi:10.1111/eci.13001

Cited by 17 publications

(10 citation statements)

References 56 publications

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“…This may represent an early sign of endothelial dysfunction in people with diabetes, because we observed no differences between the groups in terms of endothelial function at baseline. Our results might also indicate that people with diabetes may benefit from an alternate dosing regimen, perhaps twice-daily dosing, which has been suggested previously [30]. Our previous results on platelet function also support this hypothesis [12].…”

Section: Discussionsupporting

confidence: 87%

Differential vascular effects of aspirin in people with Type 2 diabetes without cardiovascular disease and matched controls without diabetes

Vernstrøm¹,

Laugesen²,

Grove

et al. 2019

Diabet. Med.

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Aim We investigated whether the effect of low‐dose aspirin on endothelium‐dependent vasodilation and arterial stiffness in people with Type 2 diabetes is different from a matched control group. We examined acute and chronic effects, and effects over the 24h dosing interval. Methods In an open‐label parallel group intervention study, we included 21 participants with Type 2 diabetes and 21 age‐ and sex‐matched controls. Endothelium‐dependent vasodilation was assessed as the reactive hyperaemia index (lnRHI) measured by peripheral arterial tonometry (EndoPAT®). Arterial stiffness was assessed as pulse wave velocity (PWV) measured by applanation tonometry (SphygmoCor®). Measurements were performed prior to aspirin intake and 1h after aspirin administration (75 mg). Participants were then treated for 6 days, and measurements were repeated at 24 h and 1 h after aspirin intake. Results Baseline lnRHI did not differ between groups. The controls had an immediate increase in lnRHI after the first aspirin tablet. This was not observed in participants with diabetes (difference between groups; P < 0.05). After 1 week, both groups demonstrated increased lnRHI compared with baseline (P < 0.01). In participants with diabetes, lnRHI was significantly lower 24 h after aspirin administration compared with 1 h after administration (P < 0.05). This difference was not observed in controls (P = 0.84, difference between groups; P = 0.12). The effect on PWV did not differ between groups. Conclusion Aspirin had a reduced immediate effect on endothelium‐dependent vasodilation in participants with diabetes. Both groups had improved endothelial function after 1 week of treatment. Further, the effect of aspirin on endothelial function may be declining during a 24 h dosing interval in people with Type 2 diabetes. (Clinical Trial Registry No: 2016‐000515‐32)

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Section: Discussionsupporting

confidence: 87%

Differential vascular effects of aspirin in people with Type 2 diabetes without cardiovascular disease and matched controls without diabetes

Vernstrøm¹,

Laugesen²,

Grove

et al. 2019

Diabet. Med.

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“…Especially in diabetes mellitus, an attenuated response to clopidogrel and aspirin therapy has been shown. [36][37][38][39] However, in our study cohort we could not identify diabetes as discriminator in the chi-squared automatic interaction detection analysis for inadequate treatment response, proving that the novel more potent antiplatelet agents ticagrelor and prasugrel seem to overcome this shortcoming.…”

Section: Discussionmentioning

confidence: 61%

Platelet reactivity patterns in patients treated with dual antiplatelet therapy

Winter

Schneeweiss

Cremer

et al. 2019

Eur J Clin Investigation

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Aim The aim of the present study was to investigate the patterns of platelet reactivity and discriminators of therapeutic response to dual antiplatelet therapy (DAPT) with aspirin and ticagrelor or prasugrel in patients with acute coronary syndrome (ACS). Design In this multicentre prospective observational study, 492 patients with ACS were enrolled. Platelet aggregation was determined by multiple electrode aggregometry after stimulation with adenosine diphosphate (ADP) or arachidonic acid (AA) as agonists in the maintenance phase of treatment with prasugrel or ticagrelor. Results Age emerged as the strongest variable influencing aspirin response status: The mean AA‐induced platelet aggregation in patients <49 years of age was 49% higher than in those >49 years (13.1 U vs 8.8 U; P = 0.011). The second strongest discriminator of aspirin response was sex: Male patients had a 40% higher AA‐induced platelet aggregation values than female patients (9.5 U vs 6.8 U; P = 0.026). Platelet count emerged as the only variable influencing ADP antagonists response status showing that patients with platelet count >320 g/L displayed higher ADP‐induced platelet aggregation. About 12% of patients had high on‐treatment platelet reactivity (HTPR) to aspirin, 3% and 4% a HTPR to prasugrel and ticagrelor, respectively, and only 2% displayed HTPR to dual antiplatelet therapy. Conclusion When potent platelet inhibitors as prasugrel and ticagrelor are administered with aspirin, HTPR to DAPT plays only a marginal role.

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“…Diabetes is characterized by a low-grade inflammation [39] explaining the typical complications of the disease through endothelial dysfunction, hyperreactivity of platelets, and elevated levels of pro-coagulant mediators [40,41]. Hyperglycemic conditions were reported to limit lipopolysaccharide (LPS)-induced neutrophil degranulation and the following release of granular proteins, i.e., MPO and NE [42,43].…”

Section: Nets In Diabetesmentioning

confidence: 99%

Neutrophil Extracellular Traps and Cardiovascular Diseases: An Update

Bonaventura

Vecchiè

Abbate

et al. 2020

Cells

Self Cite

120

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Neutrophil extracellular traps (NETs) are formed by decondensed chromatin, histones, and neutrophil granular proteins and have a role in entrapping microbial pathogens. NETs, however, have pro-thrombotic properties by stimulating fibrin deposition, and increased NET levels correlate with larger infarct size and predict major adverse cardiovascular (CV) events. NETs have been involved also in the pathogenesis of diabetes, as high glucose levels were found to induce NETosis. Accordingly, NETs have been described as drivers of diabetic complications, such as diabetic wound and diabetic retinopathy. Inflammasomes are macromolecular structures involved in the release of pro-inflammatory mediators, such as interleukin-1, which is a key mediator in CV diseases. A crosstalk between the inflammasome and NETs is known for some rheumatologic diseases, while this link is still under investigation and not completely understood in CV diseases. In this review, we summarized the most recent updates about the role of NETs in acute myocardial infarction and metabolic diseases and provided an overview on the relationship between NET and inflammasome activities in rheumatologic diseases, speculating a possible link between these two entities also in CV diseases.

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Aspirin in primary prevention for patients with diabetes: Still a matter of debate

Cited by 17 publications

References 56 publications

Differential vascular effects of aspirin in people with Type 2 diabetes without cardiovascular disease and matched controls without diabetes

Differential vascular effects of aspirin in people with Type 2 diabetes without cardiovascular disease and matched controls without diabetes

Platelet reactivity patterns in patients treated with dual antiplatelet therapy

Neutrophil Extracellular Traps and Cardiovascular Diseases: An Update

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