Does chronic smoking influence fibrinolytic potential in Type 1 diabetes mellitus?

Abstract

Tissue-type plasminogen activator (t-PA) and plasminogen activator inhibitor (PAI-1) were studied in 18 smokers and 18 closely matched non-smokers, all of whom had Type 1 diabetes mellitus (DM). None of the patients had advanced complications of diabetes. The t-PA and PAI-1 antigen levels were measured in plasma before and after venous occlusion, and were normal in Type 1 diabetes regardless of smoking status. Platelet PAI-1 levels were also measured and were found to be normal both in smokers and non-smokers. In smokers with Type 1 DM, plasma PAI-1 was significantly correlated with triglycerides. The normal fibrinolytic potential found in smokers with diabetes contrasts starkly with the significantly elevated plasma PAI-1 reported in smokers without diabetes. In smokers, triglycerides may effect low levels of PAI-1 release into plasma; this process may be significantly augmented in the presence of smoking-induced insulin resistance. The lack of endogenous insulin release in Type 1 diabetes may obviate the characteristic rise in plasma PAI-1 found in smokers who do not have diabetes.

Do plasminogen activator inhibitor (PAI‐1) or tissue plasminogen activator PAI‐1 complexes predict complications in Type 1 diabetes: The Pittsburgh Epidemiology of Diabetes Complications Study

“…reported that the fibrinolytic defence system is impaired in many patients with Type 1 and Type 2 diabetes irrespective of age or diabetes duration [15]. Though all the mechanism whereby PAI‐1 changes in diabetes might produce a hypofibrinolytic state are not clear, it should be recognized that several well‐established cardiovascular risk factors such as smoking [16,17], hypertriglyceridaemia [3,17] and obesity [18] are also associated with a decreased fibrinolytic activity. Of particular relevance to the current analyses is the correlation with triglycerides, which was the major independent multivariate predictor of CAD, and that with HbA 1 , the major predictor of nephropathy.…”

Effects of Lifestyle on Hemostasis, Fibrinolysis, and Platelet Reactivity

“…It seems that higher plasma levels of fibrinogen and viscosity are the main contributors to higher coagulability found in smokers, whereas the lower fibrinolytic potential is mainly attributed to an increase in PAI-1 activity and possibly also a decrease in tPA activity and lower plasminogen levels. 107,228,229,244…”

Gender Differences in the Relation between Fibrinogen, Tissue-type Plasminogen Activator Antigen and Markers of Insulin Resistance: Effects of Smoking

“…It is possible that smoking affects especially the response of insulin to glucose, and not so much the basic insulin levels. Similarly, the finding of lower tPA-ag in female smokers seems surprising, since no association between smoking and tPA-ag is found in other studies (38,39). However the number of women in these studies was limited, and no extended data on tPA-ag and smoking for women in particular are available.…”