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The Influence of Haemoglobin A1c Levels on Platelet Aggregation and Platelet Turnover in Patients with Coronary Artery Disease Treated with Aspirin.

Neergaard-Petersen S, Hvas AM, Grove EL, Larsen SB, Gregersen S, Kristensen SD - PLoS ONE (2015)

Bottom Line: Hyperglycaemia may attenuate the antiplatelet effect of aspirin and thereby increase the risk of cardiovascular events.Platelet turnover was evaluated by immature platelets using flow cytometry and platelet activation by soluble P-selectin.These associations were mainly evident in non-diabetic and prediabetic CAD patients.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.

ABSTRACT

Background: Hyperglycaemia may attenuate the antiplatelet effect of aspirin and thereby increase the risk of cardiovascular events. We investigated the influence of increased haemoglobin A1c (HbA1c) levels on platelet aggregation and turnover in a large cohort of patients with coronary artery disease (CAD) with type 2 diabetes, prediabetes or no diabetes.

Methods: In this observational study, we included 865 stable CAD patients on 75 mg aspirin as mono-therapy of whom 242 patients had type 2 diabetes and were receiving antidiabetic drugs. Among 623 patients without diabetes, we classified 303 patients with prediabetes (HbA1c ≥5.7-6.4% [39-47 mmol/mol]) naive to antidiabetic drugs. Platelet aggregation was evaluated by the Multiplate Analyzer using arachidonic acid and collagen and by the VerifyNow Aspirin. Platelet turnover was evaluated by immature platelets using flow cytometry and platelet activation by soluble P-selectin.

Results: CAD patients with type 2 diabetes had higher platelet aggregation (all p-values <0.01), platelet turnover (immature platelet count, p<0.01) and platelet activation (p<0.001) than patients without diabetes. CAD patients with prediabetes had increased platelet aggregation (p = 0.02) and platelet count (p = 0.02) compared with patients without diabetes. Increased levels of HbA1c correlated positively with increased platelet aggregation using arachidonic acid (r = 0.19, p<0.0001), collagen (r = 0.10, p<0.01) and VerifyNow (r = 0.15, p<0.0001), and with platelet count (r = 0.08, p = 0.01), immature platelet count (r = 0.11, p<0.001) and soluble P-selectin (r = 0.15, p<0.0001). These associations were mainly evident in non-diabetic and prediabetic CAD patients.

Conclusions: CAD patients with prediabetes and diabetes may have attenuated antiplatelet effect of aspirin compared with CAD patients without diabetes. This may be related to increased platelet count in patients with prediabetes. Increased levels of HbA1c correlated positively, though weakly, with increased platelet aggregation, platelet turnover and platelet activation.

No MeSH data available.


Related in: MedlinePlus

Correlation between haemoglobin A1c and platelet aggregation and platelet turnover.Correlation between HbA1c and A) platelet aggregation induced by arachidonic acid 1.0 mM and B) immature platelet count in patients with coronary artery disease (n = 861). Patients without diabetes (no antidiabetic drugs, n = 620) are marked with light grey and patients with type 2 diabetes (on antidiabetic drugs, n = 241) are marked in dark grey.
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pone.0132629.g002: Correlation between haemoglobin A1c and platelet aggregation and platelet turnover.Correlation between HbA1c and A) platelet aggregation induced by arachidonic acid 1.0 mM and B) immature platelet count in patients with coronary artery disease (n = 861). Patients without diabetes (no antidiabetic drugs, n = 620) are marked with light grey and patients with type 2 diabetes (on antidiabetic drugs, n = 241) are marked in dark grey.

Mentions: In the whole cohort of CAD patients, increased levels of HbA1c correlated significantly, though weakly, with platelet aggregation induced by AA (r = 0.19, p = 0.0001, Fig 2) and collagen (r = 0.10, p<0.01) and the VerifyNow Aspirin (r = 0.15, p<0.0001). Levels of HbA1c correlated positively with soluble P-selectin (r = 0.15, p<0.0001) and platelet count (r = 0.08, p = 0.01). Furthermore, HbA1c levels correlated significantly, though weakly, with increased platelet turnover assessed by IPC (r = 0.11, p = 0.001, Fig 2), but not IPF (r = 0.06, p = 0.08) and MPV (r = 0.04, p = 0.21).


The Influence of Haemoglobin A1c Levels on Platelet Aggregation and Platelet Turnover in Patients with Coronary Artery Disease Treated with Aspirin.

Neergaard-Petersen S, Hvas AM, Grove EL, Larsen SB, Gregersen S, Kristensen SD - PLoS ONE (2015)

Correlation between haemoglobin A1c and platelet aggregation and platelet turnover.Correlation between HbA1c and A) platelet aggregation induced by arachidonic acid 1.0 mM and B) immature platelet count in patients with coronary artery disease (n = 861). Patients without diabetes (no antidiabetic drugs, n = 620) are marked with light grey and patients with type 2 diabetes (on antidiabetic drugs, n = 241) are marked in dark grey.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4493028&req=5

pone.0132629.g002: Correlation between haemoglobin A1c and platelet aggregation and platelet turnover.Correlation between HbA1c and A) platelet aggregation induced by arachidonic acid 1.0 mM and B) immature platelet count in patients with coronary artery disease (n = 861). Patients without diabetes (no antidiabetic drugs, n = 620) are marked with light grey and patients with type 2 diabetes (on antidiabetic drugs, n = 241) are marked in dark grey.
Mentions: In the whole cohort of CAD patients, increased levels of HbA1c correlated significantly, though weakly, with platelet aggregation induced by AA (r = 0.19, p = 0.0001, Fig 2) and collagen (r = 0.10, p<0.01) and the VerifyNow Aspirin (r = 0.15, p<0.0001). Levels of HbA1c correlated positively with soluble P-selectin (r = 0.15, p<0.0001) and platelet count (r = 0.08, p = 0.01). Furthermore, HbA1c levels correlated significantly, though weakly, with increased platelet turnover assessed by IPC (r = 0.11, p = 0.001, Fig 2), but not IPF (r = 0.06, p = 0.08) and MPV (r = 0.04, p = 0.21).

Bottom Line: Hyperglycaemia may attenuate the antiplatelet effect of aspirin and thereby increase the risk of cardiovascular events.Platelet turnover was evaluated by immature platelets using flow cytometry and platelet activation by soluble P-selectin.These associations were mainly evident in non-diabetic and prediabetic CAD patients.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.

ABSTRACT

Background: Hyperglycaemia may attenuate the antiplatelet effect of aspirin and thereby increase the risk of cardiovascular events. We investigated the influence of increased haemoglobin A1c (HbA1c) levels on platelet aggregation and turnover in a large cohort of patients with coronary artery disease (CAD) with type 2 diabetes, prediabetes or no diabetes.

Methods: In this observational study, we included 865 stable CAD patients on 75 mg aspirin as mono-therapy of whom 242 patients had type 2 diabetes and were receiving antidiabetic drugs. Among 623 patients without diabetes, we classified 303 patients with prediabetes (HbA1c ≥5.7-6.4% [39-47 mmol/mol]) naive to antidiabetic drugs. Platelet aggregation was evaluated by the Multiplate Analyzer using arachidonic acid and collagen and by the VerifyNow Aspirin. Platelet turnover was evaluated by immature platelets using flow cytometry and platelet activation by soluble P-selectin.

Results: CAD patients with type 2 diabetes had higher platelet aggregation (all p-values <0.01), platelet turnover (immature platelet count, p<0.01) and platelet activation (p<0.001) than patients without diabetes. CAD patients with prediabetes had increased platelet aggregation (p = 0.02) and platelet count (p = 0.02) compared with patients without diabetes. Increased levels of HbA1c correlated positively with increased platelet aggregation using arachidonic acid (r = 0.19, p<0.0001), collagen (r = 0.10, p<0.01) and VerifyNow (r = 0.15, p<0.0001), and with platelet count (r = 0.08, p = 0.01), immature platelet count (r = 0.11, p<0.001) and soluble P-selectin (r = 0.15, p<0.0001). These associations were mainly evident in non-diabetic and prediabetic CAD patients.

Conclusions: CAD patients with prediabetes and diabetes may have attenuated antiplatelet effect of aspirin compared with CAD patients without diabetes. This may be related to increased platelet count in patients with prediabetes. Increased levels of HbA1c correlated positively, though weakly, with increased platelet aggregation, platelet turnover and platelet activation.

No MeSH data available.


Related in: MedlinePlus