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LOW FASTING GLUCOSE IS ASSOCIATED WITH ENHANCED THROMBIN GENERATION AND UNFAVORABLE FIBRIN CLOT PROPERTIES IN DIABETICS WITH HIGH CARDIOVASCULAR RISK
A2012 JACC March 17, 2015 Volume 65, Issue 10S
Valvular Heart Disease Low Fasting Glucose Is Associated with Enhanced Thrombin Generation and Unfavorable Fibrin Clot Properties in Diabetics with High Cardiovascular Risk Poster Contributions Poster Hall B1 Sunday, March 15, 2015, 3:45 p.m.-4:30 p.m. Session Title: Novel Markers of Vascular Risk Abstract Category: 43. Vascular Medicine: Basic Presentation Number: 1223-332 Authors: Grzegorz Gajos, Jaroslaw Zalewski, Anetta Undas, Jagienllonian University Medical College, Krakow, Poland
Background: To investigate the effect of low blood glucose on thrombin generation and fibrin clot properties in type 2 diabetes (T2DM).
Methods: In 165 patients with T2DM and high cardiovascular risk, we measured ex vivo plasma fibrin clot permeation [Ks], turbidity and efficiency of fibrinolysis including clot lysis time [t50%], together with thrombin generation and platelet activation markers in relation to fasting blood glucose.
Results: Patients with asymptomatic low fasting glucose (<4.5 mmol/l) (n=38) had lower Ks (p=0.0001), prolonged t50% (p<0.0001), higher peak thrombin generation (p=0.002) and a trend towards higher plasma CD40 ligand (p=0.09) as compared to patients with glucose ≥ 4.5 mmol/l (n=127). In comparison to medium glucose group (4.5-6.0 mmol/l), subjects with low glycemia had lower Ks (-11%, p<0.001), prolonged t50% (+10%, p<0.001) and higher peak thrombin generation (+21.3%, p=0.002). Kinetics of fibrin formation was unaffected by low glucose. A U-shape relationship was observed between glycemia and the following factors: peak thrombin generation, Ks and t50%. Only in patients with HbA1c<6.0% (42 mmol/mol) (n=26) fasting glucose positively correlated with Ks (r=0.53, P=0.006) and inversely with t50% (r=-0.46, P=0.02). In multiple linear regression analysis, fasting glycemia was the independent predictor of Ks (F=6.6, df=2, P=0.002), t50% (F=8.0, df=2, P=0.0005) and peak thrombin generation after adjustment for age, fibrinogen, HbA1c, insulin treatment and T2DM duration. Conclusion: In T2DM patients fasting glycemia <4.5 mmol/l is associated with enhanced thrombin formation and formation of denser fibrin clots displaying lower lysability, especially when strict glycemia control was achieved (HbA1c<6.0%).
Valvular Heart Disease Low Fasting Glucose Is Associated with Enhanced Thrombin Generation and Unfavorable Fibrin Clot Properties in Diabetics with High Cardiovascular Risk Poster Contributions Poster Hall B1 Sunday, March 15, 2015, 3:45 p.m.-4:30 p.m. Session Title: Novel Markers of Vascular Risk Abstract Category: 43. Vascular Medicine: Basic Presentation Number: 1223-332 Authors: Grzegorz Gajos, Jaroslaw Zalewski, Anetta Undas, Jagienllonian University Medical College, Krakow, Poland
Background: To investigate the effect of low blood glucose on thrombin generation and fibrin clot properties in type 2 diabetes (T2DM).
Methods: In 165 patients with T2DM and high cardiovascular risk, we measured ex vivo plasma fibrin clot permeation [Ks], turbidity and efficiency of fibrinolysis including clot lysis time [t50%], together with thrombin generation and platelet activation markers in relation to fasting blood glucose.
Results: Patients with asymptomatic low fasting glucose (<4.5 mmol/l) (n=38) had lower Ks (p=0.0001), prolonged t50% (p<0.0001), higher peak thrombin generation (p=0.002) and a trend towards higher plasma CD40 ligand (p=0.09) as compared to patients with glucose ≥ 4.5 mmol/l (n=127). In comparison to medium glucose group (4.5-6.0 mmol/l), subjects with low glycemia had lower Ks (-11%, p<0.001), prolonged t50% (+10%, p<0.001) and higher peak thrombin generation (+21.3%, p=0.002). Kinetics of fibrin formation was unaffected by low glucose. A U-shape relationship was observed between glycemia and the following factors: peak thrombin generation, Ks and t50%. Only in patients with HbA1c<6.0% (42 mmol/mol) (n=26) fasting glucose positively correlated with Ks (r=0.53, P=0.006) and inversely with t50% (r=-0.46, P=0.02). In multiple linear regression analysis, fasting glycemia was the independent predictor of Ks (F=6.6, df=2, P=0.002), t50% (F=8.0, df=2, P=0.0005) and peak thrombin generation after adjustment for age, fibrinogen, HbA1c, insulin treatment and T2DM duration. Conclusion: In T2DM patients fasting glycemia <4.5 mmol/l is associated with enhanced thrombin formation and formation of denser fibrin clots displaying lower lysability, especially when strict glycemia control was achieved (HbA1c<6.0%).