Elsevier

Thrombosis Research

Volume 90, Issue 4, 15 May 1998, Pages 181-190
Thrombosis Research

REGULAR ARTICLE
Shear-Induced Platelet Adhesion and Aggregation on Subendothelium Are Increased in Diabetic Patients

https://doi.org/10.1016/S0049-3848(98)00050-4Get rights and content

Abstract

Increased platelet aggregation has been suggested to play a role in the accelerated atherosclerosis of diabetics. However the physiological relevance of the aggregation tests has been questioned. The purpose of this study was to determine platelet activation in diabetic patients, using a novel device—the cone and plate(let) analyzer—to measure shear-induced platelet adhesion and aggregation on extracellular matrix (ECM). Whole blood platelet adhesion and aggregation in patients with noninsulin-dependent diabetes mellitus n=82 and in nondiabetic controls n=71 were compared. Clinical and laboratory characteristics of the diabetic patients were analyzed for possible correlation with parameters of platelet activity. Patients with diabetes had a significantly increased platelet activation compared to nondiabetic subjects, demonstrated by an increased adhesion to the ECM (surface coverage, 23% [95% confidence interval, 22–25%] vs. 19% [95% confidence interval, 18–20%], respectively) and an increased average size of the ECM-bound aggregates (54 μm2 [95% confidence interval, 51–57 μm2] vs. 47 μm2 [95% confidence interval, 43–51 μm2], respectively). Platelet adhesion in the diabetic group was found to correlate with triglyceride levels r=0.36 and hematocrit values r=0.31 and inversely with high-density lipoprotein cholesterol levels r=0.30. There were no correlation, however, between parameters of platelet reactivity and duration of diabetes, vascular complications and low-density lipoprotein levels. Our data demonstrate an increased platelet adhesion and aggregation in diabetic patients and suggest a modulatory role of diabetic dyslipidemia.

Section snippets

Patients

The study population consisted of 82 NIDDM patients who were being followed at a diabetes clinic. All patients had been managed by diet and/or treatment with oral hypoglycemic agents for at least 1 year after diabetes was diagnosed and were not ketosis-prone. The diabetics were outpatients and had not been hospitalized during the 6 months prior to the study. The control group consisted of 71 healthy volunteers who came from a nearby community and showed no evidence of cardiovascular diseases or

Patient Characteristics

The mean duration of diabetes among the 82 NIDDM patients in this study was 12.4+8.5 (range 1–27) years. Forty-five patients (55%) were receiving treatment with the oral hypoglycemic agents glyburide (12 patients) or metformin (9 patients) or both (24 patients). Thirty patients (37%) were being treated with insulin, six (7%) with glyburide, metformin and insulin, and one patient by diet alone. All patients were evaluated for diabetic complications; the results are shown in Table 1. Of the 29

Discussion

The results obtained with the CPA method for evaluating platelet function in vitro show that the platelets of patients with NIDDM have an increased interaction with the ECM compared to those of nondiabetic controls. This increased platelet activity and interaction with the ECM is manifested as a significant increase in SC and AS of the adhered particles. These data confirm the results of previous studies showing an increased aggregation response in diabetic patients 13, 14, 15. However, they

Acknowledgements

This research was supported by a grant from the National Council for Research and Development, Israel and Deutsche Forschungsanstalt Luft and Raumfahrt. We thank Dr. Rima Dardik and Dr. Ilia Tamarin for their help in the analysis of platelet activity, and Ilana Gelernter for her help with the statistical analysis of the data.

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