%0 Journal Article
%T Increased Atherothrombotic Burden in Patients with Diabetes Mellitus and Acute Coronary Syndrome: A Review of Antiplatelet Therapy
%A Karthik Balasubramaniam
%A Girish N. Viswanathan
%A Sally M. Marshall
%A Azfar G. Zaman
%J Cardiology Research and Practice
%D 2012
%I Hindawi Publishing Corporation
%R 10.1155/2012/909154
%X Patients with diabetes mellitus presenting with acute coronary syndrome have a higher risk of cardiovascular complications and recurrent ischemic events when compared to nondiabetic counterparts. Different mechanisms including endothelial dysfunction, platelet hyperactivity, and abnormalities in coagulation and fibrinolysis have been implicated for this increased atherothrombotic risk. Platelets play an important role in atherogenesis and its thrombotic complications in diabetic patients with acute coronary syndrome. Hence, potent platelet inhibition is of paramount importance in order to optimise outcomes of diabetic patients with acute coronary syndrome. The aim of this paper is to provide an overview of the increased thrombotic burden in diabetes and acute coronary syndrome, the underlying pathophysiology focussing on endothelial and platelet abnormalities, currently available antiplatelet therapies, their benefits and limitations in diabetic patients, and to describe potential future therapeutic strategies to overcome these limitations. 1. Introduction A PubMed (Medline) search was performed using the following terms either singly or in combination: diabetes, type 2 diabetes mellitus, cardiovascular risk, hypercoagulability, prothrombotic, acute coronary syndrome, endothelial dysfunction, antiplatelet, platelet dysfunction, aspirin, clopidogrel, and glycoprotein IIb/IIIa inhibitor. All papers relevant to platelet and endothelial abnormalities in diabetes mellitus, acute coronary syndrome, and current antiplatelet therapies were considered. Diabetes mellitus (DM) can be described as a metabolic disorder of multiple aetiology characterised by chronic hyperglycaemia with disturbances of carbohydrate, fat, and protein metabolism resulting from defects of insulin secretion, insulin action, or a combination of both [1]. The world prevalence of diabetes among adults (aged 20¨C79 years) was approximately 6.4%, affecting 285 million adults in 2010 and is predicted to rise to 7.7%, affecting 439 million adults by 2030 [2]. Between 2010 and 2030, there will be a 69% increase in numbers of adults with diabetes in developing countries and a 20% increase in developed countries. Globally, diabetes is likely to be the fifth leading cause of death [3]. The most prevalent form of DM is type 2 diabetes mellitus (T2DM). Insulin resistance usually precedes the onset of T2DM and is commonly accompanied by other related metabolic abnormalities such as hyperglycaemia, dyslipidaemia, hypertension, and prothrombotic factors, all of which contribute to the increased
%U http://www.hindawi.com/journals/crp/2012/909154/