Association Between Increased Platelet P-Selectin Expression and Obesity in Patients With Type 2 Diabetes
A BARI 2D (Bypass Angioplasty Revascularization Investigation 2 Diabetes) substudy
- David J. Schneider, MD1,
- Regina M. Hardison, MS2,
- Neuza Lopes, MD3,
- Burton E. Sobel, MD1,
- Maria Mori Brooks, PHD2 and
- the Pro-Thrombosis Ancillary Study Group
- 1Cardiology Division and Cardiovascular Research Institute, University of Vermont, Burlington, Vermont;
- 2Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania;
- 3University of São Paolo Heart Institute, São Paolo, Brazil.
- Corresponding author: David J. Schneider, david.schneider{at}uvm.edu
Abstract
OBJECTIVE To determine whether obesity increases platelet reactivity and thrombin activity in patients with type 2 diabetes plus stable coronary artery disease.
RESEARCH DESIGN AND METHODS We assessed platelet reactivity and markers of thrombin generation and activity in 193 patients from nine clinical sites of the Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D). Blood taken at the time of enrollment was used for assay of the concentration of prothrombin fragment 1.2 (PT1.2, released when prothrombin is activated) and fibrinopeptide A (FPA, released when fibrinogen is cleaved). Platelet activation was identified with the use of flow cytometry in response to 0, 0.2, and 1 μmol/l adenosine diphosphate (ADP).
RESULTS Concentrations of FPA, PT1.2, and platelet activation in the absence of agonist were low. Greater BMI was associated with higher platelet reactivity in response to 1 μm ADP as assessed by surface expression of P-selectin (r = 0.29, P < 0.0001) but not reflected by the binding of fibrinogen to activated glycoprotein IIb-IIIa. BMI was not associated with concentrations of FPA or PT1.2. Platelet reactivity correlated negatively with A1C (P < 0.04), was not related to the concentration of triglycerides in blood, and did not correlate with the concentration of C-reactive peptide.
CONCLUSIONS Among patients enrolled in this substudy of BARI 2D, a greater BMI was associated with higher platelet reactivity at the time of enrollment. Our results suggest that obesity and insulin resistance that accompanies obesity may influence platelet reactivity in patients with type 2 diabetes.
Footnotes
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The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C. Section 1734 solely to indicate this fact.
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- Received October 14, 2008.
- Accepted February 4, 2009.
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Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. See http://creativecommons.org/licenses/by-nc-nd/3.0/ for details.
- © 2009 by the American Diabetes Association.
