Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, TX 75235-9047, USA.
Diab Vasc Dis Res. 2011 Oct;8(4):245-53. doi: 10.1177/1479164111420890.
The global prevalence of diabetes mellitus (DM) continues to climb, and is accompanied by an increase in DM associated complications, most often manifesting as coronary heart disease. Platelet dysfunction has been implicated as a central contributor to the increased risk of coronary artery disease in patients with DM, and it is not surprising that the anti-platelet agent, clopidogrel, has been shown to have efficacy in both short and long term outcomes in patients with acute coronary syndrome and those undergoing percutaneous coronary intervention. However, accumulating data suggest a clinically relevant sub-optimal clopidogrel response in some patients with DM. The exact mechanism of these observations is not yet fully understood, but appears to be related to reduced concentrations of circulating clopidogrel active metabolite, with less variability in pharmacodynamic and clinical response suggested by the evaluation of newer P2Y(12) antagonists, such as prasugrel and ticagrelor. More research is needed to better understand both the pharmacology and clinical consequences of these observations.
全球糖尿病（DM）的患病率持续攀升，同时 DM 相关并发症也随之增加，最常见的表现为冠心病。血小板功能障碍被认为是导致 DM 患者发生冠心病风险增加的一个核心因素，因此抗血小板药物氯吡格雷在急性冠脉综合征和经皮冠状动脉介入治疗患者的短期和长期结局中均显示出疗效也就不足为奇了。然而，越来越多的数据表明，一些 DM 患者的氯吡格雷反应存在临床相关的不理想情况。这些观察结果的确切机制尚未完全阐明，但似乎与循环中氯吡格雷活性代谢物浓度降低有关，新型 P2Y(12)拮抗剂（如普拉格雷和替格瑞洛）的药效动力学和临床反应的变异性较小也提示了这一点。需要进一步研究以更好地了解这些观察结果的药理学和临床后果。
