Diabetes and Aspirin Resistance

Abstract

Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in patients with diabetes mellitus (DM). DM is considered as a coronary artery disease equivalent for future risk of vascular events. There are 3 different classes of platelet-inhibiting drugs: cyclooxygenase-1 (COX-1) inhibitors (aspirin), ADP P2Y12 receptor antagonists (thienopyridines), and platelet glycoprotein (GP) IIb/IIIa inhibitors, and these platelet inhibitors are mostly used for the prevention and treatment of atherothrombotic disorders. Aspirin inhibits the COX-1 enzyme and therefore blocks platelet thromboxane A2 synthesis. In 2007, the American Diabetes Association (ADA) and the American Heart Association (AHA) jointly recommended primary prevention strategy in those with diabetes, and that was modified by The U.S. Preventive Services Task Force recently; they did not differentiate their recommendations based on the presence or absence of diabetes. ADA recommends the use of low-dose aspirin (75–162 mg/day) for secondary prevention of cerebrovascular and cardiovascular events in all diabetic patients. In this chapter we discuss the cardiovascular risk in diabetes, what aspirin resistance means, the mechanism of aspirin resistance in diabetes including platelet activity, methods that are useful to identify aspirin resistance, and methods and management of aspirin resistance.