**4. Role of antiplatelet agents in primary prevention of CVD**

Increased physical activity, dietary modifications and pharmacologic interventions are the key methods in management of dyslipidemia in type 2 diabetes mellitus (Mooradian, 2008). The Antithrombotic Trialists' Collaboration meta-analysis found that antiplatelet therapy reduces the relative risk of any serious vascular event by 25% in patients at high risk for a cardiovascular (CV) event (Antithrombotic Trialist' Collaboration, 2002). Antiplatelet agents are used for primary and secondary prevention of CVD in type 2 diabetes mellitus patients. Antiplatelet therapy is needed in the management of diabetes mellitus because there is an increase of platelet aggregability and adhesiveness due to platelet and endothelial dysfunction, impaired coagulation cascade, and fibrinolysis process among diabetic individuals compared to nondiabetic individuals (Colwell & Nesto, 2003). Consequently, the balance in normal hemostasis is shifted to favor thrombosis and accelerated atherosclerosis and results in increasing CVD (Colwell & Nesto, 2003). For primary prevention of cardiovascular diseases, type 2 diabetes mellitus patients with high risk acquiring cardiovascular events such as those with family history of cardiovascular disease, hypertension, obesity (BMI > 30 kg/m2), smoking, dyslipidemia and albuminuria (Colwell, 2004). Several types of antiplatelet agents is being utilized for prevention of CVD which including aspirin, ticlopidine, clopidogrel and glycoprotein (Gp) IIb-IIIa antagonist such as abciximab, eptifibatide and tirofiban (Patrono et al., 2004; American Diabetes Association, 2006; Colwell & Nesto, 2003). Aspirin is one of the most common antiplatelet that been suggested in prevention of CVD in diabetes. Clopidogrel and ticlopidine are theinopyridine antiplatelet agents that generally suggested if patients are contraindicated to aspirin (American Diabetes Association, 2006). In contrast, Gp IIb-IIIa antagonist is usually given to diabetes patients who undergo precutaneous coronary intervention in order to intensify the antiplatelet therapy and to reduce the risk of procedure related thrombotic complication and reoccurrence of CV event (Patrono et al., 2004).
