Cardiovascular prognosis for diabetic patients, associated with blood clotting strength...Up to 3.4x increase in fatality rate
Feb 12, 2025
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A joint research team led by Chung Young-hoon and Chung Moon-ki of the Department of Circulatory Medicine at Chung-Ang University Gwangmyeong Hospital and Cho Sung-soo of the Department of Cardiology at Gangnam Severance Hospital recently published the findings in the famous international journal 'American Heart Association: Cardiovascular Intervention (JACC).'
Cardiovascular disease is the world's leading cause of death. Diabetes is one of the important causes of coronary artery disease such as angina and myocardial infarction.
Diabetes damages the endothelial cells of the coronary arteries, allowing inflammation and cholesterol to build up well, increasing unstable atherosclerotic plaque. It is known to increase the incidence of angina and myocardial infarction.
Diabetes patients frequently perform stent procedures (percutaneous coronary intervention, PCI) due to the high incidence of coronary artery disease, but the risk of thrombosis and retraction is relatively high even after the procedure. To reduce this risk, the treatment guidelines recommend relatively strong use of antiplatelet drugs and cholesterol regulators. However, despite these guidelines, the recurrence rate of ischemic events is still higher compared to patients without diabetes. Therefore, there is an urgent need for additional treatment policies to reduce the possibility of recurrence of cardiovascular disease.
◇ Cohesive strength, another important risk factor
In general, it has been known that arterial disease and thrombosis are mainly determined by 'platelet activity', and venous disease and thrombosis are mainly determined by 'coagulation strength'. However, a recent study shows that both factors are important in the development of thrombus in cardiovascular disease, even though there are differences in degree. In the COMPASS study, a large-scale clinical study, it was found that in cardiovascular disease patients with high-risk factors such as diabetes, using Rivaroxaban, an anticoagulant, in combination with aspirin, reduced the recurrence of clinical events by 24% rather than using aspirin alone.
To find scientific evidence for previous clinical outcomes with insufficient evidence, Professor Young-Hoon Jeong's research team conducted a study analysis of 2501 people who underwent stenting (G-NUH registry). Of the total patients, 970 (38.8%) had diabetes, and in all patients, 'glycosylated hemoglobin (HbA1c)' and 'coagulation intensity (MA levels identified by the thromboelasticity test )' were measured. Diabetes patients had significantly increased blood 'coagulation strength', and 'coagulation strength' was closely related to the degree of control of diabetes (HbA1c). Poor management of diabetes (glycosylated hemoglobin 7.0 or higher) and 'coagulation strength' were shown to be complementarily closely related to the prognosis of patients after stenting.
◇Customized treatment required according to blood 'coagulation strength'
According to the study, the recurrence of cardio-cerebrovascular events was 2.5 times greater in the case of diabetes and high 'coagulation intensity' at the same time at 4 years of follow-up than in the case of neither. In addition, if the degree of control of diabetes was poor (glycosylated hemoglobin 7.0 or higher) and the blood clotting intensity was high, the recurrence of cardio-cerebrovascular events was increased by a factor of 2.2. In particular, this difference was more pronounced in cardiovascular death, showing an increase in risk of 3.4 and 2.7 times, respectively.
The relationship between diabetes and the risk of severe bleeding has shown significant results in various existing studies. In the present study, it was confirmed that only in the case of low 'coagulation intensity', the risk of bleeding increased by 3.4 to 4 times when diabetes or poor diabetes control (glycosylated hemoglobin 7.0 or higher) was present.
Through these analysis results, the team confirmed that diabetes (or degree of diabetes control) and blood 'coagulation strength' play an important role in the occurrence of ischemic and hemorrhagic cardio-cerebrovascular events after stenting. It is believed to be an important basis for further empowering the need to use customized antithrombotic agents along with active diabetes control in improving the prognosis of diabetic patients in the future.
Professor Cho Seong-soo of cardiology at Gangnam Severance Hospital, who conducted the study, said "Diabetes patients have more frequent recurrence of cardio-cerebrovascular events and poor prognosis after stenting compared to non-diabetic patients" "This study evaluates the limitations of uniform antiplatelet drug use to improve prognosis in diabetic patients"
Chung Young-hoon, a professor of circulatory technology at Chung-Ang University Gwangmyeong Hospital, said "Diabetes patients not only increase inflammation levels, but also increase the blood's coagulation strength" at the same time."The development of current testing devices makes it easier to identify these risk factors in clinical practice, and we will strive to develop treatment guidelines that can provide appropriate patient-specific treatment according to these risk factor evaluations in the future."
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This article was translated by Naver AI translator.
