Sex differences in the effect of diabetesmellitus on platelet reactivity and coronary thrombosis: From the Assessment of Dual Antiplatelet Therapy with Drug-Eluting Stents (ADAPT-DES) study

作者：Giustino, Gennaro; Redfors, Bjorn; 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.; Ozan, M. Ozgu; Stone, Gregg W.

来源：International Journal of Cardiology, 2017, 246: 20-25.

DOI：10.1016/j.ijcard.2017.05.091

• Diabetes mellitus
• Sex
• Platelet reactivity
• Coronary thrombosis

Background: Whether the consequences of diabetes mellitus (DM) areworse forwomen than formen treatedwith drug-eluting stents (DES) and antiplatelet therapy remain unclear.
Methods: Patients from the Assessment of Dual Antiplatelet TherapyWith Drug-Eluting Stents study were stratified according to sex and DMstatus. We investigated the sex-specific effect of DMon high on-clopidogrel platelet reactivity (HPR), defined as a P2Y(12) 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, 829werewomenwith DM(9.6%) and 1954weremenwith DM (16.2%). The prevalence of insulin-treatedDM(ITDM) was greater inwomen (p < 0.0001). Bymultivariable logistic regression, DM was associated with a greater likelihood of HPR that was uniformbetween sexes (p(int) = 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 DMto 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 associatedwith subtypes of DMwas 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; p(int) = 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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