State-of-the-Art: Hypo-responsiveness to Oral Antiplatelet Therapy in Patients with Type 2 Diabetes Mellitus
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SECONDARY PREVENTION + INTERVENTION (M O' DONOGHUE, SECTION EDITOR)
State-of-the-Art: Hypo-responsiveness to Oral Antiplatelet Therapy in Patients with Type 2 Diabetes Mellitus Dharam J. Kumbhani & Steven P. Marso & Carlos A. Alvarez & Darren K. McGuire
# Springer Science+Business Media New York 2015
Abstract Diabetes mellitus is a global pandemic, associated with a high burden of cardiovascular disease. There are multiple platelet derangements in patients with diabetes, and antiplatelet drugs remain the first-line agents for secondary prevention as well as for high-risk primary prevention among patients with diabetes. This review provides a summary of oral antiplatelet drug hypo-responsiveness in patients with diabetes, specifically aspirin and clopidogrel resistance. Topics discussed include antiplatelet testing, definitions used to define hypo-response and resistance, its prevalence, association with clinical outcomes, and strategies to mitigate resistance. The role of prasugrel and ticagrelor, as well as investigational agents, is also discussed.
Keywords Diabetes mellitus . Antiplatelet resistance . High on-treatment platelet reactivity . Aspirin resistance . Clopidogrel resistance . Platelets . Antiplatelet This article is part of the Topical Collection on Secondary Prevention + Intervention D. J. Kumbhani : S. P. Marso UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-9047, USA D. J. Kumbhani e-mail: [email protected] S. P. Marso e-mail: [email protected] C. A. Alvarez Texas Tech University Health Sciences Center, 5920 Forest Park Road, Dallas, TX 75235, USA e-mail: [email protected] D. K. McGuire (*) UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-8830, USA e-mail: [email protected]
Introduction Diabetes mellitus is a rapidly expanding global pandemic, with nearly 400 million people worldwide having diagnosed diabetes mellitus [1]. Its prevalence worldwide is expected to double in the next decade [2]. An equal or likely higher number of people worldwide have either undiagnosed diabetes or impaired fasting glucose [3, 4]. Coupled with a steep increase in childhood obesity and a proliferation of other risk factors such as excessive caloric intake and sedentary behaviors worldwide [5, 6], it is one of the most important public health problems of our time. Indeed, it is estimated that one in three people born in the twenty-first century will develop diabetes mellitus during their lifetime [7]. In the USA, prevalence rates appear to have plateaued at ~8 % between 2008 and 2012, but incidence rates continue to rise among minority populations [8]. Diabetes is also one of the most important risk factors for the development of coronary atherosclerosis, including myocardial infarction (MI) [7, 9, 10], and is considered by some a CAD risk equivalent for the risk of future MI and cardiovascular death in adults age over 40 without known CAD [11, 12]. Among patients presenting with an acute coronary syndrome (ACS), patients wit
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