Affiliation:
1. First Department of Cardiology, Hippokration Hospital, Athens Medical School, 114 Vas. Sofias avenue, 11527, Athens, Greece
Abstract
Background:
Diabetes mellitus (DM) is on the rise globally. Its prevalence has nearly doubled
during the last two decades and it is estimated to affect 8.8% of the global population.
Cardiovascular disease (CVD) is the leading cause of death in diabetic population and despite
modern anti-inflammatory and cardioprotective therapeutic strategies diabetic patients have at
least a twice fold risk of cardiovascular events. Prothrombotic state in DM is associated with
multiple determinants such as platelet alterations, oxidative stress, endothelial changes,
circulating mediators. Thus, proper antithrombotic strategies to reduce the risk of CVD in this
population is critical.
Methods:
This article reviews the current antiplatelet and anticoagulant
agents in the aspect of primary and secondary prevention of CVD in the diabetic population.
Results:
The use of aspirin may be considered only at high-risk patients in the absence of
contraindications. Cangrelor was not inferior to clopidogrel in preventing the composite outcome
of CV death, myocardial infraction and revascularization without increasing major bleeding.
Triple therapy in the subpopulation with DM significantly reduced the composite primary
outcome of CV death, myocardial infraction or repeat target lesion revascularization. That was
not the case for stent thrombosis, which was similar in both groups. Importantly, triple therapy
did not result in increased bleeding complications, which were similar in both groups. However,
cilostazol is linked to various adverse effects (e.g., headache, palpitations, and gastrointestinal
disturbances) that drive many patients to withdrawal.
Conclusion:
In conclusion, DM is a
rapidly growing disease that increases the risk of CVD, AF, and CV mortality. Proper
antithrombotic strategies to reduce CVD risk in DM is a necessity. Also, new antithrombotic
treatments and combination therapies may play a critical role to overcome antiplatelet resistance
in DM patients and reduce morbidity and mortality attributed to CVD.
Publisher
Bentham Science Publishers Ltd.
Subject
Drug Discovery,Pharmacology
Cited by
16 articles.
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