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Analyzing Platelet Subpopulations by Multi-color Flow Cytometry
Published on: June 10, 2025
Relation of augmented platelet reactivity to the magnitude of distribution of atherosclerosis
Friederike K Keating1, Deborah A Whitaker, Samer S Kabbani
1Cardiology Unit, University of Vermont College of Medicine, 111 Colchester Avenue, Burlington, VT 05401 USA. friederike.keating@vtmednet.org
Insights
Platelet reactivity, a marker of cardiovascular risk, increases with the number of affected vascular territories in atherosclerotic vascular disease. Patients with coronary artery disease and diabetes also show heightened platelet activation.
Area of Science:
- Cardiovascular Medicine
- Hematology
- Atherosclerosis Research
Background:
- Atherosclerotic vascular disease affects multiple territories and is linked to cardiovascular events.
- Platelet reactivity is a key factor in thrombotic events.
- The relationship between disease extent and platelet activation needs further elucidation.
Purpose of the Study:
- To investigate the correlation between the extent of atherosclerotic vascular disease distribution and platelet reactivity.
- To determine if patients with multi-territory involvement exhibit higher platelet activation.
- To examine the influence of comorbidities like diabetes on platelet reactivity in coronary artery disease.
Main Methods:
- Blood samples from 130 patients with known atherosclerotic vascular disease were analyzed.
- Vascular disease territories included coronary artery disease, cerebrovascular disease, and peripheral arterial disease.
- Platelet reactivity was measured using flow cytometry assessing P-selectin expression in response to adenosine diphosphate.
Main Results:
- Patients with atherosclerotic disease in multiple territories (>1) demonstrated significantly greater platelet reactivity (P-selectin expression) compared to those with single-territory involvement (p=0.01).
- Platelet reactivity increased with the number of affected vascular territories: 1 territory (6.4%), 2 territories (10.0%), and 3 territories (10.1%).
- Patients with coronary artery disease and diabetes mellitus showed higher P-selectin expression than those with coronary artery disease alone (p<0.02).
Conclusions:
- Platelet reactivity is elevated in patients with more extensive atherosclerotic vascular disease.
- Comorbidities such as diabetes mellitus further enhance platelet reactivity in coronary artery disease patients.
- These findings suggest that patients with widespread vascular disease may benefit more from potent antiplatelet therapies.
Abstract:
The extent of luminal involvement of atherosclerotic vascular disease and platelet reactivity portend subsequent cardiovascular events. This study was designed to determine whether platelet reactivity correlates with the extent of the territorial distribution of vascular disease. Blood was obtained from 130 patients who had known atherosclerotic vascular disease categorized as being in > or =1 of the following territories: coronary artery disease (CAD; n = 89), cerebrovascular disease (n = 36), and peripheral arterial disease (n = 61). Platelet reactivity, i.e., the activation of platelets in response to a low concentration of adenosine diphosphate (0.2 micromol/L), was measured using flow cytometry. Patients with vascular disease in >1 territory compared with those with disease in only 1 territory had greater platelet reactivity with respect to P-selectin expression (p = 0.01). The percentages of platelets expressing P-selectin (mean +/- SD) were 6.4 +/- 4.2 in patients who had involvement of 1 territory (n = 88), 10.0 +/- 6.8 in those who had involvement of 2 territories (n = 28), and 10.1 +/- 9.9 in those who had involvement of 3 territories (n = 14). Patients who had CAD and diabetes mellitus had greater P-selectin expression than did those who had CAD without diabetes (p <0.02 for interaction). Thus, platelet reactivity is greater in patients who have more extensive territorial distribution of atherosclerotic vascular disease and in those who have CAD and diabetes mellitus. Accordingly, patients who have more widely distributed vascular disease are likely to derive particular benefit from antiplatelet regimens that suppress platelet function to a greater extent.
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