**8. Conclusion**

86 Dyslipidemia - From Prevention to Treatment

The platelet glycoprotein (GP) IIb/IIIa complex receptor antagonists block activity at the fibrinogen binding site on platelet (Colwell & Nesto, 2003). These agents are useful in type 2 diabetes patients with acute coronary syndrome and in those undergoing percutaneous coronary interventions (Colwell & Nesto, 2003). These agents are administered intravenously with a rapid onset of action and short half-life (Natarajan et al., 2008). Numerous studies have been performed comparing various GP IIb/IIIa inhibitors. Currently, three different GP IIb/IIIa inhibitors (abciximab, eptifibatide, and tirofiban) are approved for clinical use. This group of drugs was mainly study for secondary prevention of CVD in diabetes patients. Evidence from three trials revealed that among 1,262 diabetes patients, use of these agents was associated with reduction in mortality from 4.5% to 2.5% (p=0.031) (Bhatt et al., 2000). In another meta-analysis of six large trials, with 6,458 patients with diabetes and acute coronary syndromes, GP IIb/IIIa inhibitor therapy was associated with a significant mortality reduction at 30 days, from 6.2% to 4.6% CI(0.59-0.92, p=0.007) (Roffi et al., 2001). Nonetheless, the role of GP IIb/IIIa inhibitors in primary prevention of CVD in type 2 diabetes mellitus has not been

**6. Appropriate selection of antiplatelet agents for primary prevention of CVD** 

Among all choices, there are considerations to be taken into account before types of antiplatelet agents chosen. According to American Diabetes Association (2011), aspirin (75- 162mg/day) should be considered for primary prevention of cardiovascular disease in type 2 diabetes patients for men (>50 years) and women (>60 years) with at least one additional major risk factor (family history of cardiovascular disease, hypertension, smoking, dyslipidemia or albuminuria). The other types of antiplatelet agents either alone or combination with aspirin therapy has no established role in primary prevention of cardiovascular disease in type 2 diabetes patients. In contrast, aspirin should not be recommended for CVD prevention for diabetes patients with low CVD risk (10-year CVD risk <5%, such as in men <50 and women <60 years of age with no additional CVD risk factors, since the potential adverse effects from bleeding likely outweigh the potential benefits (ADA, 2011). A same recommendation goes to type 2 diabetes patients with multiple other risk factors (e.g. 10-year risk 5-10%), in which clinical judgment is required

Aspirin once daily (75-100 mg) is recommended in primary prevention of CVD in type 2 diabetes patients when antiplatelet prophylaxis has a favorable benefit/risk profile (Patrono et al., 2004). For effectiveness of primary prevention strategy, patients should be followed on a regular basis and examined for signs and symptoms of any cardiovascular diseases. In consideration of dose-dependent GI toxicity and its potential impact on compliance, physicians are encouraged to use the lowest dose of aspirin that was shown to be effective in each clinical setting (Patrono et al., 2001). Aspirin should not be given to patients with gastrointestinal ulcerations; best tolerated after food. In conclusion, bleeding and gastrointestinal complications are the most common adverse effects of aspirin. Thus, the patients on aspirin

should be monitored for stomach pain, heartburn, nausea and bleeding tendency.

**5.5 GP IIb/IIIa inhibitors** 

**in type 2 diabetes patients** 

(American Diabetes Association, 2011).

**7. Monitoring of aspirin efficacy and adverse effects** 

justified; therefore it is not recommended for this purpose.

Dyslipidemia is one of the risk factors for acquiring cardiovascular disease in patients with type 2 diabetes. In absent for contraindication, type 2 diabetes patients with dyslipidemia are eligible for primary prevention of cardiovascular disease although the routine use has not been documented. Aspirin plays a key role in primary prevention strategy of cardiovascular disease in type 2 diabetes patients. With limited studies and evidence for other antiplatelet agents, their role in primary prevention has not been established.
