Vitamin D levels and platelet reactivity in diabetic patients receiving dual antiplatelet therapy

• Published in: Vascular pharmacology Vol. 120; p. 106564
• Main Authors: Verdoia, Monica, Pergolini, Patrizia, Nardin, Matteo, Rolla, Roberta, Negro, Federica, Kedhi, Elvin, Suryapranata, Harry, Marcolongo, Marco, Carriero, Alessandro, De Luca, Giuseppe
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.09.2019; Elsevier Science Ltd
• Subjects: Acute Coronary Syndrome - blood; Acute Coronary Syndrome - diagnosis; Acute Coronary Syndrome - drug therapy; Acute coronary syndromes; Adenosine diphosphate; Aged; Aged, 80 and over; Antagonists; Antiplatelet therapy; Aspirin - adverse effects; Aspirin - therapeutic use; Biomarkers - blood; Calciferol; Cardiovascular diseases; Cholesterol; Clopidogrel; Clopidogrel - adverse effects; Clopidogrel - therapeutic use; Creatinine; Diabetes; Diabetes mellitus; Diabetes Mellitus - blood; Diabetes Mellitus - diagnosis; Diuretics; Drug Therapy, Combination; Dual antiplatelet therapy; Female; Health risks; Heart diseases; Heart surgery; Hemoglobin; Humans; Hyperreactivity; Hypersensitivity; Inflammation; Male; Middle Aged; Normality; Nutrient deficiency; Percutaneous Coronary Intervention; Platelet aggregation; Platelet Aggregation - drug effects; Platelet Aggregation Inhibitors - adverse effects; Platelet Aggregation Inhibitors - therapeutic use; Platelets; Prasugrel Hydrochloride - adverse effects; Prasugrel Hydrochloride - therapeutic use; Quartiles; Reactivity; Renal failure; Risk analysis; Risk Factors; Statins; Supplements; Therapy; Ticagrelor - adverse effects; Ticagrelor - therapeutic use; Time Factors; Treatment Outcome; Vitamin D; Vitamin D - blood; Vitamin D Deficiency - blood; Vitamin D Deficiency - diagnosis; Vitamin deficiency; Platelet aggregation; Vitamin D; Diabetes mellitus; Dual antiplatelet therapy
• ISSN: 1537-1891; 1879-3649
• DOI: 10.1016/j.vph.2019.106564

Hypovitaminosis D represents an emerging cardiovascular risk factor, and especially among higher-risk subsets of patients, such as in those with diabetes mellitus. The anti-inflammatory and anti-thrombotic properties of vitamin D, in fact, could be even more beneficial among diabetics, where platelet hyperreactivity and suboptimal response to antiplatelet drugs has been associated with poorer outcomes. However, no study has so far evaluated the impact of vitamin D levels on platelet reactivity and high-on treatment platelet reactivity (HRPR) among diabetic patients receiving dial antiplatelet therapy (DAPT). Our population is represented by a consecutive cohort ofdiabetic patients treated with DAPT (ASA + clopidogrel or ticagrelor or dose-adjusted prasugrel) for an acute coronary syndrome or elective PCI, undergoing platelet reactivity assessment at 30–90 days post-discharge. Aggregation was assessed by multiple-electrode aggregometry. HRPR was defined for values above the lower limit of normality (in non-treated patients). We included 440 patients, that were divided according to quartiles values of vitamin D (< 9.4; 9.4–15.59; 15.6–21.64; ≥ 21.65 ng/ml). Among them, 31 were excluded as chronically treated with vitamin D supplementation. Lower vitamin D quartiles were associated with more advanced age (p = 0.01), female gender (p = 0.04), renal failure (p = 0.005), history of previous MI (p = 0.01), CABG and use of diuretics (p = 0.003), severe coronary disease (p = 0.002), but lower ejection fraction (p = 0.001), treatment with statins (p = 0.04) and new ADP-antagonists (p = 0.002). Vitamin D levels related with higher HbA1c (p = 0.001), cholesterol (p = 0.02) and creatinine (p = 0.004) and lower hemoglobin (p = 0.004). The prevalence of HRPR with ASA was low and not related to vitamin D quartiles (3.4% vs 2.7% vs 1.8% vs 2.1%, p = 0.44; adjusted OR[95%CI] = 1.16[0.60–2.26], p = 0.67). The prevalence of HRPR for ADP antagonists was associated to hypovitaminosis D (40.2% vs 29.1% vs 29.4% vs 25.5%, p = 0.03; (adjusted OR[95%CI] = 1.76[1.04–2.98], p = 0.036for I vs II-IV quartile). The impact of vitamin D quartiles, was significant only in patients on new ADP antagonists (n = 225, of whom 81 on prasugrel 5 mg; p = 0.03; adjusted OR[95%CI] = 3.12[1.34–7.49], p = 0.009) but not with clopidogrel (p = 0.85, adjusted OR[95%CI] = 1.05[0.49–2.24], p = 0.89). Among diabetic patients receiving dual antiplatelet therapy for an acute coronary syndrome or elective percutaneous coronary intervention, severe vitamin D deficiency is associated with a higher ADP-mediated platelet reactivity and rate of HRPR, and especially for new ADP-antagonists over clopidogrel. [Display omitted]