Format

Send to

Choose Destination
Int J Cardiol. 2017 Nov 1;246:20-25. doi: 10.1016/j.ijcard.2017.05.091.

Sex differences in the effect of diabetes mellitus on platelet reactivity and coronary thrombosis: From the Assessment of Dual Antiplatelet Therapy with Drug-Eluting Stents (ADAPT-DES) study.

Author information

1
The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
2
Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA.
3
The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA. Electronic address: roxana.mehran@mountsinai.org.
4
Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA; Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, NY, USA.
5
Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA; Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada; Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, NJ, USA.
6
Helios Amper-Klinikum, Dachau, Germany.
7
Heart Center, University of Freiburg, Bad Krozingen, Germany.
8
Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA; Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, NY, USA; Shaare Zedek Medical Center, Jerusalem, Israel.
9
Sanger Heart and Vascular Institute, Carolinas HealthCare System, Charlotte, NC, USA.
10
Wellmont CVA Heart Institute, Kingsport, TN, USA.
11
Cedars-Sinai Medical Center, Los Angeles, CA, USA; Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, MN, USA.
12
Lehigh Valley Health Network, Allentown, PA, USA.
13
Reid Heart Center, FirstHealth of the Carolinas, Pinehurst, NC, USA.
14
The Ohio State University Wexner Medical Center, Columbus, OH, USA.
15
LeBauer-Brodie Center for Cardiovascular Research and Education/Cone Health, Greensboro, NC, USA.
16
The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA.
17
Department of Medicine, New York Methodist Hospital, Brooklyn, NY, USA.

Abstract

BACKGROUND:

Whether the consequences of diabetes mellitus (DM) are worse for women than for men treated with drug-eluting stents (DES) and antiplatelet therapy remain unclear.

METHODS:

Patients from the Assessment of Dual Antiplatelet Therapy With Drug-Eluting Stents study were stratified according to sex and DM status. We investigated the sex-specific effect of DM on high on-clopidogrel platelet reactivity (HPR), defined as a P2Y12 reaction units ≥208, and the adjusted association of DM on the 2-year risk for coronary thrombotic events (CTE), defined as spontaneous myocardial infarction or definite or probable stent thrombosis.

RESULTS:

Out of 8582 patients included in the study, 829 were women with DM (9.6%) and 1954 were men with DM (16.2%). The prevalence of insulin-treated DM (ITDM) was greater in women (p<0.0001). By multivariable logistic regression, DM was associated with a greater likelihood of HPR that was uniform between sexes (pint=0.88). Following adjustment for baseline variables and HPR, in women a stepwise increase in risk for CTEs was observed in the transition from no DM to non-ITDM (NITDM) (adjusted hazard ratio [adjHR]: 1.31; 95% CI: 0.78-2.18) to ITDM (adjHR: 2.69; 95% CI: 1.23-3.45). This increase in risk associated with subtypes of DM was of smaller magnitude in men (for NITDM, adjHR: 1.04; 95% CI: 0.77-1.39; for ITDM, adjHR: 1.46; 95% CI: 1.05-2.03; pint=0.016).

CONCLUSIONS:

In a population treated with DES and antiplatelet therapy, the risk for CTE associated with DM seems to be greater in women and was independent of HPR.

KEYWORDS:

Coronary thrombosis; Diabetes mellitus; Platelet reactivity; Sex

PMID:
28867009
DOI:
10.1016/j.ijcard.2017.05.091
[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Elsevier Science Icon for Lehigh Valley Health Network -Body Family Medical Library
Loading ...
Support Center