Statin therapy and inflammation in patients with diabetes treated with high dose aspirin

Chaudhary, Rahul; Bliden, Kevin P.; Garg, Jalaj; Mohammed, Nafees; Tantry, Udaya S.; Mathew, Denny; Tóth, Peter P.; Franzese, Christopher; Gesheff, Martin G.; Pandya, Shachi; Gurbel, Paul A.

doi:10.1016/j.jdiacomp.2016.05.002

Cited by 10 publications

(9 citation statements)

References 28 publications

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“… 22 Chaudhary et al found that statin with high-dose aspirin therapy was associated with a reduction in urinary 11-DH-TXB 2 levels in diabetic patients, indicating that urinary 11-DH-TXB 2 levels may be a marker to determine the anti-inflammatory effect for therapy. 23 In the present study, we found that the plasma 11-DH-TXB 2 concentration in the CAL group was significantly higher than that of the NCAL group. Moreover, it was significantly higher in patients with CAL than in patients with NCAL after aspirin treatment.…”

Section: Discussionsupporting

confidence: 44%

Immature platelets and antiplatelet therapy response to aspirin in Kawasaki disease

Che

Long

et al. 2018

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IntroductionKawasaki disease is a kind of systemic vasculitis that mainly damages moderate and small-sized blood vessels, and is a leading cause of coronary artery lesions (CAL). Antiplatelet therapy is a routine component of Kawasaki disease treatment strategies. So it is important to evaluate the antiplatelet effect of aspirin because of the individual biological variability of antiplatelet effect of aspirin. The immature platelet fraction (IPF) has attracted particular attention as it may influence the antiplatelet effect of aspirin. This study investigated the prognostic factors for evaluating the degree of vasculitis and the effect of antiplatelet therapy in children with Kawasaki disease.Materials and methodsBlood samples were collected from 44 patients with Kawasaki disease before aspirin treatment and 7 to 10 days after treatment. The IPF counts, percentage of the IPF, and highly fluorescent IPF were detected by a Sysmex XE-5000 instrument. The levels of 11-dehydrothromboxane B2 (11-DH-TXB2), soluble CD40 ligand (sCD40L), and soluble P-selectin (sP-selectin) were measured by ELISA. The correlation between the measured factors and the degree of coronary artery damage in Kawasaki disease was analyzed.ResultsWe found that 11-DH-TXB2, sP-selectin, and sCD40L levels were much more elevated in the CAL group than in the non-coronary artery lesions (NCAL) group before aspirin treatment. The concentrations of 11-DH-TXB2, sCD40L, sP-selectin, and IPF were reduced after aspirin treatment in the NCAL group but not the CAL group. This is related to the degree of coronary artery damage in Kawasaki disease patients. Additionally, 11-DH-TXB2, sCD40L, sP-selectin, and IPF were positively correlated with the degree of coronary artery damage in Kawasaki disease patients.ConclusionThe current study suggests that the presence of high plasma concentrations of 11-DH-TXB2, sCD40L, sP-selectin, and IPF can be considered a risk factor and experimental biomarker for CAL in Kawasaki disease patients.

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Section: Discussionsupporting

confidence: 44%

Immature platelets and antiplatelet therapy response to aspirin in Kawasaki disease

Che

Long

et al. 2018

DDDT

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“…Traditional risk factors for dysglycemia in PLHIV include: older age [4, 47], male gender [9, 48], family history of diabetes [49], higher BMI [9, 50], high WHR [51], smoking [52], alcohol consumption [52], hypertension [29] and physical inactivity [28]. We did not find a statistically significant association for any of the above with dysglycemia in this study.…”

Section: Discussionmentioning

confidence: 57%

C - reactive protein and interleukin - 6 levels among human immunodeficiency virus -infected patients with dysglycemia in Tanzania

et al. 2019

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Background Chronic inflammation has been associated with dysglycemia among people living with HIV (PLHIV). There is however, limited data regarding this phenomenon in sub-Sahara Africa (SSA). Therefore we assessed the levels of C-reactive protein ( CRP) and Interleukin 6 (IL-6) on a cohort of PLHIV and its associations with dysglycemia in Tanzania. Methods We conducted a cross-sectional study at the Infectious Disease Clinic (IDC) in Tanzania from March to May 2018. Purposive sampling was used to identify participants who had an undetectable viral load, were on 1st line anti-retroviral therapy (ART) and had an overnight fast. The WHO stepwise approach for non-communicable disease (NCD) surveillance was used to collect data. Fasting blood glucose and blood glucose after 75 g oral glucose load was measured, and Enzyme-linked immunosorbent assay (ELISA) was used to test for inflammatory markers (IL-6 and CRP). Associations were explored using the Chi square test and binary logistic regression was performed to estimate the odds ratios. A p -value less than 0.05 was considered statistically significant. Results A total of 240 participants were enrolled. Forty two percent were overweight/obese (> 25 kg/m 2 ), 89% had a high waist to height ratio. The median ART duration was 8(5–10) years. The prevalence of dysglycemia among our cohort of PLHIV was 32%. High CRP was associated with a 2.05 increased odds of having dysglycemia OR 2.05 (1.15–3.65) ( p = 0.01). Taking stavudine was associated with a 1.99 odds of having dysglycemia OR 1.99 (1.04–3.82) ( p = 0.03).We did not find a significant association between IL-6 and dysglycemia. Conclusion High CRP and taking stavudine were significantly associated with dysglycemia among PLHIV with undetectable viral load.

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“…36 Statins also markedly enhance antiplatelet effects of aspirin in diabetics. 48 In the JPAD trial, problems were the open design as well as the poorly controlled medications in the comparator group. Furthermore, events, such as the development of angina pectoris, were also considered as primary study endpoint although it is known from other primary prevention trials that they are not aspirin-sensitive 22 and might have diluted the statistical power.…”

Section: The Primary Prevention Trials In Diabetesmentioning

confidence: 99%

“…It has been shown previously that statin cotreatment is associated with an approximately 50% decrease in urinary excretion of the thromboxane metabolite: 25% versus 57% (p ¼ 0.01). 48 Statins will retard the progression of the macroangiopathy in diabetics and, therefore, also reduce the atherothrombotic risk. 9 A recent Danish population-based cohort study for a real-world scenario in diabetic patients with high rates of statins, aspirin, and other cotreatments found only small increase in mortality for diabetics but no change in the incidence of MIs in the absence of angiographically significant coronary artery disease, suggesting that diabetics without CV disease had the same risk of MI as patients without diabetes.…”

Section: Adjunctive Treatmentsmentioning

confidence: 99%

Aspirin and Primary Prevention in Patients with Diabetes—A Critical Evaluation of Available Randomized Trials and Meta-Analyses

et al. 2019

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Primary prevention of cardiovascular events with aspirin in patients with elevated cardiovascular risk, including diabetics, is currently under intense discussion. Data from meta-analyses suggests that the efficacy of aspirin in these patients is low, whereas there is a significantly increased bleeding tendency. However, meta-analyses are based on trials that differ in many important aspects, including study selection. Fresh insights were expected from the ASCEND trial, by far the largest primary, randomized, placebo-controlled prevention trial in diabetics without known cardiovascular disease. There was a small but significant reduction in serious cardiovascular events by aspirin (8.6% vs. 9.6%) but also a significant increase in major bleeding: 4.1% versus 3.2%. Unfortunately, this trial did not meet the desired annual rate of elevated vascular risk of ≥ 2%. It was only 1.2 to 1.3%, and thus in the range of other primary prevention trials in low-risk patients. Apart from potential compliance problems, possible explanations for the small cardioprotective effect of antiplatelet treatment include a healthy lifestyle as well as improved vascular protection by comedication with vasoactive and anti-inflammatory drugs, such as statins or antihypertensive agents, as well as proton-pump inhibitors that might modify bleeding, specifically in the upper gastrointestinal tract—the most frequently affected site. Also, the introduction of new antidiabetic drugs with more favorable cardiovascular effects may in part explain the low event rate. ASCEND, similar to ARRIVE, did not study patients at elevated (as planned) but only at low vascular risk and, therefore, was largely confirmatory of earlier primary prevention trials.

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Statin therapy and inflammation in patients with diabetes treated with high dose aspirin

Cited by 10 publications

References 28 publications

Immature platelets and antiplatelet therapy response to aspirin in Kawasaki disease

Immature platelets and antiplatelet therapy response to aspirin in Kawasaki disease

C - reactive protein and interleukin - 6 levels among human immunodeficiency virus -infected patients with dysglycemia in Tanzania

Aspirin and Primary Prevention in Patients with Diabetes—A Critical Evaluation of Available Randomized Trials and Meta-Analyses

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