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

Gennaro Giustino, Björn Redfors, Roxana Mehran, Ajay J. Kirtane, Usman Baber, Philippe Genereux, Bernhard Witzenbichler, Franz Josef Neumann, Giora Weisz, Akiko Maehara, Michael J. Rinaldi, D. Christopher Metzger, Timothy D. Henry, David A. Cox, Peter L. Duffy, Ernest L. Mazzaferri, Bruce R. Brodie, Thomas D. Stuckey, George D. Dangas, Sorin J. Brener & 2 others M. Ozgu Ozan, Gregg W. Stone

Research output: Contribution to journalArticle

5 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)20-25
Number of pages6
JournalInternational Journal of Cardiology
Volume246
DOIs
StatePublished - Nov 1 2017
Externally publishedYes

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Coronary Thrombosis
Drug-Eluting Stents
Sex Characteristics
Diabetes Mellitus
Blood Platelets
Therapeutics
clopidogrel
Insulin
Stents
Thrombosis
Logistic Models
Myocardial Infarction

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Giustino, Gennaro ; Redfors, Björn ; Mehran, Roxana ; Kirtane, Ajay J. ; Baber, Usman ; Genereux, Philippe ; Witzenbichler, Bernhard ; Neumann, Franz Josef ; Weisz, Giora ; Maehara, Akiko ; Rinaldi, Michael J. ; Metzger, D. Christopher ; Henry, Timothy D. ; Cox, David A. ; Duffy, Peter L. ; Mazzaferri, Ernest L. ; Brodie, Bruce R. ; Stuckey, Thomas D. ; Dangas, George D. ; Brener, Sorin J. ; Ozgu Ozan, M. ; Stone, Gregg W. / 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. In: International Journal of Cardiology. 2017 ; Vol. 246. pp. 20-25.
@article{efcc7b1869604032997019d2bf7a9811,
title = "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",
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.",
author = "Gennaro Giustino and Bj{\"o}rn Redfors and Roxana Mehran and Kirtane, {Ajay J.} and Usman Baber and Philippe Genereux and Bernhard Witzenbichler and Neumann, {Franz Josef} and Giora Weisz and Akiko Maehara and Rinaldi, {Michael J.} and Metzger, {D. Christopher} and Henry, {Timothy D.} and Cox, {David A.} and Duffy, {Peter L.} and Mazzaferri, {Ernest L.} and Brodie, {Bruce R.} and Stuckey, {Thomas D.} and Dangas, {George D.} and Brener, {Sorin J.} and {Ozgu Ozan}, M. and Stone, {Gregg W.}",
year = "2017",
month = "11",
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doi = "10.1016/j.ijcard.2017.05.091",
language = "English (US)",
volume = "246",
pages = "20--25",
journal = "International Journal of Cardiology",
issn = "0167-5273",
publisher = "Elsevier Ireland Ltd",

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Giustino, G, Redfors, B, Mehran, R, Kirtane, AJ, Baber, U, Genereux, P, Witzenbichler, B, Neumann, FJ, Weisz, G, Maehara, A, Rinaldi, MJ, Metzger, DC, Henry, TD, Cox, DA, Duffy, PL, Mazzaferri, EL, Brodie, BR, Stuckey, TD, Dangas, GD, Brener, SJ, Ozgu Ozan, M & Stone, GW 2017, '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', International Journal of Cardiology, vol. 246, pp. 20-25. https://doi.org/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. / Giustino, Gennaro; Redfors, Björn; Mehran, Roxana; Kirtane, Ajay J.; Baber, Usman; Genereux, Philippe; Witzenbichler, Bernhard; Neumann, Franz Josef; Weisz, Giora; Maehara, Akiko; Rinaldi, Michael J.; Metzger, D. Christopher; Henry, Timothy D.; Cox, David A.; Duffy, Peter L.; Mazzaferri, Ernest L.; Brodie, Bruce R.; Stuckey, Thomas D.; Dangas, George D.; Brener, Sorin J.; Ozgu Ozan, M.; Stone, Gregg W.

In: International Journal of Cardiology, Vol. 246, 01.11.2017, p. 20-25.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Sex differences in the effect of diabetes mellitus on platelet reactivity and coronary thrombosis

T2 - From the Assessment of Dual Antiplatelet Therapy with Drug-Eluting Stents (ADAPT-DES) study

AU - Giustino, Gennaro

AU - Redfors, Björn

AU - Mehran, Roxana

AU - Kirtane, Ajay J.

AU - Baber, Usman

AU - Genereux, Philippe

AU - Witzenbichler, Bernhard

AU - Neumann, Franz Josef

AU - Weisz, Giora

AU - Maehara, Akiko

AU - Rinaldi, Michael J.

AU - Metzger, D. Christopher

AU - Henry, Timothy D.

AU - Cox, David A.

AU - Duffy, Peter L.

AU - Mazzaferri, Ernest L.

AU - Brodie, Bruce R.

AU - Stuckey, Thomas D.

AU - Dangas, George D.

AU - Brener, Sorin J.

AU - Ozgu Ozan, M.

AU - Stone, Gregg W.

PY - 2017/11/1

Y1 - 2017/11/1

N2 - 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.

AB - 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.

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DO - 10.1016/j.ijcard.2017.05.091

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