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Blood glucose and platelet-dependent thrombosis in patients with coronary artery disease

Michael Shechter, MD, MA, FACC^* , C. Noel Bairey Merz, MD, FACC^* , Maura J. Paul-Labrador, MPH^* and Sanjay Kaul, MD^*

^* Preventive and Rehabilitative Cardiac Center, Cedars-Sinai Burns and Allen Research Institute, Division of Cardiology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
Atherosclerosis Research Center, Cedars-Sinai Burns and Allen Research Institute, Division of Cardiology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
UCLA School of Medicine, Los Angeles, California, USA

View larger version (16K): [in a new window]   Figure 1 Correlation of fasting blood glucose and platelet-dependent thrombosis demonstrating a linear correlation (n = 42). The correlation was unchanged when the two outlier points (glucose = 9.9 and 12.2 mmol/l) or the two diabetic patients were excluded. FBG = fasting blood glucose; PDT = platelet-dependent thrombosis.

View larger version (9K): [in a new window]   Figure 2 Bar graphs showing (A) platelet-dependent thrombosis, (B) P-selectin (CD62 antigen) expression and (C) platelet aggregation in patients with fasting blood glucose (open bar) and > (closed bar) 4.9 mmol/l. Data are expressed as mean ± SD.

View larger version (48K): [in a new window]   Figure 3 Representative histological sections (hematoxylin-phloxine-safranin stain) showing the platelet-dependent thrombosis deposited (T) on porcine aortic media (M) taken from two patients: (A) a patient with blood glucose of 6.1 mmol/l, with a large thrombus area, and (B) a patient with blood glucose of 4.4 mmol/l and a smaller thrombus area.

View larger version (15K): [in a new window]   Figure 4 Plot showing interaction between FBG and plasma insulin in modifying platelet-dependent thrombosis. Patients were divided into four groups: FBG 4.9 mmol/l plus insulin levels of 126 pmol/l (n = 12); FBG 4.9 mmol/l plus insulin levels of >126 pmol/l (n = 9); FBG >4.9 mmol/l plus insulin levels of 126 pmol/l (n = 8); and FBG >4.9 mmol/l plus insulin levels of >126 pmol/l (n = 13). Data are expressed as mean ± SD (one-sided error bars). FBG = fasting blood glucose; PDT = platelet-dependent thrombosis.

View larger version (22K): [in a new window]   Figure 5 (A) Comparison of regression lines in patients with plasma insulin levels below or above normal (126 pmol/l). (B) Correlation between the ratio of plasma insulin and FBG and PDT. FBG = fasting blood glucose; PDT = platelet-dependent thrombosis.