An overview of the role of platelets in vascular disease associated with diabetes mellitus

Atherosclerotic cardiovascular disease (ASCVD) is associated with increased morbidity and mortality in subjects with diabetes mellitus (DM). The present narrative review focuses on the crucial role of platelets in the development and progression of ASCVD. Experimental studies have shown platelet hyperactivity in DM. In this context, platelet apoptosis, strongly linked to inflammatory and mitochondrial pathways, as well as platelet mediators are gaining ever more research interest. In clinical practice, the prognostic value of platelet indices, such as mean platelet volume (MPV) or platelet-lymphocyte ratio (PLR), is increasingly being investigated. Moreover, several clinical trials have suggested that antiplatelet therapy needs to be modified in subjects with DM in terms of dose and treatment duration. Dual antiplatelet therapy (DAPT) has been compared with triple antiplatelet therapy (TAPT) with the inclusion of cilostazol, with TAPT possibly being superior. Furthermore, preclinical studies have suggested an antiplatelet effect of novel antidiabetic agents, such as glucagon-like peptide-1 receptor agonists (GLP-1RAs) and sodium-glucose cotransporter-2 inhibitors (SGLT-2is), but definitive answers are still needed. More studies are required to elucidate the role of platelets in ASCVD with co-existing DM and their potential therapeutic implications.