Rapid Change of Platelet Aggregability in Acute Hyperglycemia

Summary

We examined the alteration of platelet aggregability in acute hyperglycemia during 75-gram oral glucose tolerance tests (OGTT). Twenty subjects underwent 75-gram OGTT and venous blood samples were obtained before (0 min), 60, 120 and 180 min postload. Platelet aggregability shown as the number of small platelet aggregates was measured with a novel laser-light scattering (LS) method. Platelet aggregability increased in parallel with both glucose and immunoreactive insulin (IRI) levels. The number of mean small aggregates at 60 min (12.30 ± 1.10 × 10⁴) was significantly higher than the one at 0 min (8.32 ± 0.88 × 10⁴, p <0.001), 120 min (10.63 ± 0.98 × 10⁴, p <0.05) and 180 min (8.28 ± 0.84 × 10⁴, p <0.001) (mean ± SEM). Small aggregates correlated positively with plasma glucose levels at 60 min postload (r = 0.67, p = 0.001) while not with IRI. It might be important to suppress transient hyperglycemia for preventing the onset of acute coronary syndromes that could be closely related to platelet hyperaggregability.

Key words

Platelet aggregability - hyperglycemia - glucose tolerance test

• References

• 1 Abraira C, Colwell J, Nuttall F, Sawin CT, Henderson W, Comstock JP, Emanuele NV, Levin SR, Pacold I, Lee HS. Cardiovascular events and correlates in the Veterans Affairs Diabetes Feasibility Trial. Veterans Affairs Cooperative Study on Glycemic Control and Complications in Type II Diabetes. Arch Intern Med 1997; 157: 181-8.
• 2 Janka HU. Increased cardiovascular morbidity and mortality in diabetes mellitus: identification of the high risk patient. Diabetes Res Clin Pract 1996; 30 Suppl 85-8.
• 3 Lee MW, Severson DL. Signal transduction in vascular smooth muscle: diacylglycerol second messengers and PKC action. Am J Physiol 1994; 267: C659-78.
• 4 Vlassara H. Recent progress in advanced glycation end products and diabetic complications. Diabetes 1997; 46: S19-25.
• 5 Hawthorne GC, Bartlett K, Hetherington CS, Alberti KG. The effect of high glucose on polyol pathway activity and myoinositol metabolism in cultured human endothelial cells. Diabetologia 1989; 32: 163-6.
• 6 Nathan DM, Meigs J, Singer DE. The epidemiology of cardiovascular disease in type 2 diabetes mellitus: how sweet it is ... or is it?. Lancet 1997; 350: SI4-9.
• 7 Fukuda K, Ozaki Y, Satoh K, Kume S, Tawata M, Onaya T, Sakurada K, Seto M, Sasaki Y. Phosphorylation of myosin light chain in resting platelets from NIDDM patients is enhanced: correlation with spontaneous aggregation. Diabetes 1997; 46: 488-93.
• 8 Iwase E, Tawata M, Aida K, Ozaki Y, Kume S, Satoh K, Qi R, Onaya T. A cross-sectional evaluation of spontaneous platelet aggregation in relation to complications in patients with type II diabetes mellitus. Metabolism 1998; 47: 699-705.
• 9 Masuda T, Yasue H, Ogawa H, Misumi I, Sakamoto T, Okubo H, Miyao Y, Kato H. Plasma plasminogen activator inhibitor activity and tissue plasminogen activator levels in patients with unstable angina and those with coronary spastic angina. Am Heart J 1992; 124: 314-9.
• 10 Sakamoto T, Yasue H, Ogawa H, Misumi I, Masuda T. Association of patency of the infarct-related coronary artery with plasma levels of plasminogen activator inhibitor activity in acute myocardial infarction. Am J Cardiol 1992; 70: 271-6.
• 11 Oshima S, Ogawa H, Yasue H, Okumura K, Matsuyama K, Miyagi H. Increased plasma fibrinopeptide A levels during attacks induced by hyperventilation in patients with coronary vasospastic angina. J Am Coll Cardiol 1989; 14: 150-4.
• 12 Rapold HJ, Haeberli A, Kuemmerli H, Weiss M, Baur HR, Straub WP. Fibrin formation and platelet activation in patients with myocardial infarction and normal coronary arteries. Eur Heart J 1989; 10: 323-33.
• 13 Elwood PC, Renaud S, Sharp DS, Beswick AD, O’Brien JR, Yarnell JW. Ischemic heart disease and platelet aggregation. The Caerphilly Collaborative Heart Disease Study. Circulation 1991; 83: 38-44.
• 14 Grande P, Grauholt AM, Madsen JK. Unstable angina pectoris. Platelet behavior and prognosis in progressive angina and intermediate coronary syndrome. Circulation 1990; 81: I16-9.
• 15 Ozaki Y, Satoh K, Yatomi Y, Yamamoto T, Shirasawa Y, Kume S. Detection of platelet aggregates with a particle counting method using light scattering. Anal Biochem 1994; 218: 284-94.
• 16 The expert comittee on the diagnosis and classification of diabetes mellitus. Report of the expert committee on the diagnosis and classification of diabetes mellitus. Diabetes Care 1997; 20: 1183-97.
• 17 Yasue H, Horio Y, Nakamura N, Fujii H, Imoto N, Sonoda R, Kugiyama K, Obata K, Morikami Y, Kimura T. Induction of coronary artery spasm by acetylcholine in patients with variant angina: possible role of the parasympathetic nervous system in the pathogenesis of coronary artery spasm. Circulation 1986; 74: 955-63.
• 18 Virgolini I, Kaliman J, Sinzinger H. Platelet aggregation and platelet sensitivity-behaviour during normal and abnormal glucose tolerance testing. Vasa 1989; 18: 117-21.
• 19 Giugliano D, Marfella R, Coppola L, Verrazzo G, Acampora R, Giunta R, Nappo F, Lucarelli C, D’Onofrio F. Vascular effects of acute hyperglycemia in humans are reversed by L-arginine. Evidence for reduced availability of nitric oxide during hyperglycemia. Circulation 1997; 95: 1783-90.
• 20 STohgi H, Takahashi H, Watanabe K, Kuki H, Shirasawa Y. Development of large platelet aggregates from small aggregates as determined by laser-light scattering: effects of aggregant concentration and antiplatelet medication. Thromb Haemost 1996; 75: 838-43.
• 21 Oliva PB. Pathophysiology of acute myocardial infarction, 1981. Ann Intern Med 1981; 94: 236-50.
• 22 Petito CK. Platelet thrombi in experimental cerebral infarction. Stroke 1979; 10: 192-6.
• 23 STofler GH, Stone PH, Maclure M, Edelman E, Davis VG, Robertson T, Antman EM, Muller JE. Analysis of possible triggers of acute myocardial infarction (the MILIS study). Am J Cardiol 1990; 66: 22-7.
• 24 Falcon C, Pfliegler G, Deckmyn H, Vermylen J. The platelet insulin receptor: detection, partial characterization, and search for a function. Biochem Biophys Res Commun 1998; 157: 1190-6.
• 25 Radomski MW, Palmer RM, Moncada S. An L-arginine/nitric oxide pathway present in human platelets regulates aggregation. Proc Natl Acad Sci USA 1990; 87: 5193-7.
• 26 Delmas-Beauvieux MC, Peuchant E, Thomas MJ, Dubourg L, Pinto AP, Clerc M, Gin H. The place of electron spin resonance methods in the detection of oxidative stress in type 2 diabetes with poor glycemic control. Clin Biochem 1998; 31: 221-8.