DM Dan CVD Afian

8/13/2019 DM Dan CVD Afian

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Platelet Function Platelet activation plays a pivotal role in the initiation and progression of

atherothrombosis. Aspirin:

Aspirin inhibits thromboxane (TX) A2 2-dependent platelet activation and aggregation throughirreversible inactivation of platelet cyclo-oxygenase 1 (COX-1) activity.

once-daily administration of low-dose aspirin may be associated with incomplete inhibition ofplatelet COX-1 activity and TXA 2-dependent platelet function.

Primary prevention:aspirin probably produces a modest reduction in the risk of cardiovascularevents

Secondary prevention: They analysed individual data on serious vascular (non-fatal MI, non-fatal stroke or vascular death) from approximately 4500 patients with DM in the randomizedtrials and found that treatment with antiplatelet drugs produced a proportional reduction ofabout one quarter.

Risk-benefit ratio of Aspirin: aspirin was associated with a 55% increase in the risk ofextracranial (mainly gastrointestinal) bleeding, both in people without- (the majority) andwithDM. favour aspirin use in adults with DM when the 10-year risk of cardiovascular events is


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Platelet Function P2Y12 receptor blockers: Clopidogrel, an irreversible blocker of the

adenosine diphosphate (ADP) receptor P2Y12, provides a validalternative for patients who are aspirin-intolerant or havesymptomatic peripheral vascular disease, because it has broadindications for long-term secondary prevention similar to aspirin.

In a DM substudy, a similar reduction in recurrent ischaemic eventswas seen, but in the DM cohort this was not accompanied by anincrease in bleeding.

Ticagrelor (180 mg loading dose, followed by 90 mg twice daily),was also more effective than clopidogrel (300 600 mg loading dose,followed by 75 mg daily) in reducing death from CV causes and totalmortality at 12 months in a general post-ACS cohort,281 anddecreased ischaemic events in DM patients without causingincreased bleeding.282


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Platelet Function


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Multifactorial approach


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Multifactorial approach


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Management of stable and unstable coronaryartery disease in patients with diabetes

DM is associated with a poorer prognosis in patients with acute andstable CAD

Optimal medical treatment for patients with chronic coronaryartery disease and diabetes

Beta-adrenergic blockers Blockers of the renin-angiotensin-aldosterone system (ACE-I or ARB) Lipid-lowering drug Nitrates and calcium channel blockers Ivabradine: heart-rate lowering, anti-anginal drug inhibits

primarymodulator of spontaneous diastolic depolarization in the sinusnode. Indicated in chronic stable angina in CAD patients with a contra-indication or intolerance to beta-blocker.

Antiplatelet and antithrombotic drugs Glucose control in acute coronary syndromes


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Management of stable and unstable coronaryartery disease in patients with diabetes


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Revascularization


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Revascularization


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Revascularization


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Heart Failure and DM


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Arrythmias


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Peripheral Arterial Disease


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Carotid artery disease


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Reccomendation in PAD


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Management of Microvascular disese


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Recommendation in patient-centered care

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DM Dan CVD Afian