↵*Correspondence to: Nicolas L. Plaques narrow arteries and can reduce blood flow to the heart, a condition called coronary heart disease (CHD). Baseline and CVD characteristics were similar in the two groups. Increased platelet thromboxane production as well as activation of platelet receptors for fibrinogen and or adenosine diphosphate (ADP) are often present, and can be treated with aspirin (acetylsalicylic acid) and/or receptor blockers. Failure to mitigate risk with antihyperglycemic therapy and the potential for some treatments to increase CVD risk underlies a treatment paradox. First, given the lower prevalence rate of hypertension and hypercholesterolemia and lower use of statins and anti-hypertensive agents in inflammatory arthritis patients compared with diabetes mellitus, one may speculate that classic risk factors are underreported and hence undertreated in inflammatory arthritis. This Review discusses the mechanisms by which T1DM and T2DM can lead to cardiovascular disease and how these relate to the risk factors for coronary artery disease.
Lines of investigation regarding cardiovascular health in this population are still wide open, and the Framingham Study continues to be part of this journey. Data supporting the use of clopidogrel as an alternative drug in the case of aspirin allergy or other contraindications are reviewed. Body weight, height and blood pressure were measured. Although bleeding episodes are more common with combined antiplatelet therapy for ACS than for aspirin alone, the benefit of a significant reduction in 30-day mortality appears to outweigh the risk of major bleeding. It is concluded that major advances in our understanding of the prothrombotic state in DM have been made. Evidence from controlled clinical trials supports the use of enteric-coated aspirin, 81–325 mg/day, as a primary and a secondary prevention strategy in adults with DM with high vascular risk. In ACS, combination therapy with aspirin plus clopidogrel or alternatively, aspirin plus a platelet GP IIb/IIIa inhibitor is supported by prospective trial data.
These approaches should be added to the other multifactorial preventive strategies directed at lowering the risk for major vascular events in patients with DM.