A review article realized by researchers at IDIBELLabout the situation of antiplatelet therapy in acute coronary syndromes in patients with type 2 diabetes highlights the need for new potent therapies for this population at risk.
The article has been published in the journal Circulation, the publication of reference in cardiology, and evaluates the pros and cons of the following strategies: use of new drugs with more antithrombotic capacity, an increase dose of the known ones or find the appropriate combination of platelet inhibitor drugs for each patient.
The new Cardiovascular Research Laboratory of the IDIBELL, led by José Luis Ferreiro, will begin the research in this area in collaboration with the Diabetes, Nutritional and Endocrine diseases research group at IDIBELL. The article has been realized by José Luis Ferreiro, IDIBELL researcher and cardiologist at the Hospital Universitario de Bellvitge, and Dominick Angiolillo, director of the Cardiovascular Research Center at the University of Florida.
Diabetics have cardiovascular diseases more often and also they have poorer prognosis. In fact, diabetics without coronary disease have the same risk of cardiovascular events than non-diabetics who have had a myocardial infarction. Diabetes is a predictor of ischemic heart disease (obstruction of blood vessels that supply blood to the heart) that could cause death in the short or long term. The researcher José Luis Ferreiro explains that this is because the platelet function of patients with diabetes is different: “they present alterations that make them more active and they secrete more, so that not only increases the risk of developing coronary syndrome acute but also did not respond to platelet inhibitors with the same efficiency as normal platelets”.
Response to current drugs
In recent years there have been appearing new drugs to treat coronary syndrome, including acute myocardial infarction and angina pectoris. Atherosclerotic heart disease represents the major part of heart disease and is the leading cause of death in men and particularly in diabetics. Despite it is currently available a variety of antithrombotic drugs, it continues to be used in a generic way aspirin and clopidogrel as oral antiplatelet treatment of choice. Still, up to 40% of patients, including diabetics do not respond to the action of these drugs.
The study gives a snapshot of the current status of diabetes patients as a population at high risk of cardiovascular disease and their response to current treatments; and suggests new therapeutic strategies. Ferreiro explained that there are three alternatives for the development of new therapeutic strategies: the first is the use of new antiplatelet drugs more powerful than those used so far might be like prasugrel (which is already on the market)
or ticagrelor, the second option would be to raise doses of current treatments so as to increase their effectiveness antiplatelet, and finally, combining drugs that inhibit platelets by different pathways and synergistically enhancing the effect of all drugs. ”
Ferreiro has participated in several pharmacodynamic studies at the University of Florida with the aim to compare platelet inhibition in patients with diabetes with different combinations of drugs that allow us to predict response to treatmen. One of the objectives of the new Cardiovascular Research Laboratory leading by the IDIBELL is to realize “this type of studies to optimize the combination of drugs for each patient.”
José Luis Ferreiro* and Dominick J. Angiolillo. Diabetes and Antiplatelet Therapy in Acute Coronary Syndrome. Circulation. 2011;123:798-813 doi: 10.1161/CIRCULATIONAHA.109.913376