Prevention of Cardiovascular Events in Patients With Diabetes
How Beneficial Is Dual Antiplatelet Therapy?
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Patients with diabetes mellitus (DM) are at a greater risk of cardiovascular events than patients without DM. Increased platelet reactivity is believed to be an important cause of this increased risk. One would therefore expect a greater cardiovascular benefit of more potent antiplatelet therapy in DM patients in comparison with non-DM patients. So far, this has not been observed. In DM patients with an acute coronary syndrome, fewer ischemic events were found with clopidogrel on top of aspirin (versus aspirin alone), and with a more versus less potent P2Y12 antagonist (prasugrel or ticagrelor versus clopidogrel) (all on top of aspirin), but in none of these trials was the relative benefit greater than in non-DM patients. Most of the reductions in ischemic events were observed in the first month with little or only a modest benefit afterward. It is remarkable that, in contrast with non-DM patients, no excess of bleeding events was reported with the more versus less potent antiplatelet therapies in DM patients.
Also, in large randomized prevention trials, a greater long-term benefit with more potent antiplatelet treatment has not been …