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Updated: Nov 14, 2025
A Zebrafish Model of Diabetes Mellitus and Metabolic Memory
Published on: February 28, 2013
[Atherosclerotic Cardiovascular Diseases and Type 2 Diabetes Mellitus - new Developments in the Treatment]
V Y Kalashnikov1, M S Michurova1
1Endocrinology National Medical Research Center, Moscow.
Insights
Adding low-dose rivaroxaban to aspirin significantly reduces cardiovascular events and amputations in patients with stable atherosclerotic disease, including those with peripheral artery disease.
Area of Science:
- Cardiology
- Vascular Medicine
- Pharmacology
Background:
- Type 2 diabetes mellitus management has limitations, with high rates of myocardial infarction, stroke, critical ischemia, and amputation.
- New hypoglycemic drugs show efficacy in reducing mortality and cardiovascular complications, but atherothrombotic complication prevention remains critical.
- Acetylsalicylic acid (ASA) is standard for preventing atherothrombotic events, but combinations with other antiplatelet drugs lack expected benefits.
Purpose of the Study:
- To evaluate the efficacy of adding a low-dose oral anticoagulant to ASA for preventing atherothrombotic complications in patients with stable atherosclerotic cardiovascular diseases.
- To assess the impact of combined therapy on stroke, cardiovascular death, and peripheral artery disease outcomes.
Main Methods:
- The study involved patients with stable atherosclerotic cardiovascular diseases.
- Comparison between ASA 100 mg/day alone and a combination of rivaroxaban 2.5 mg twice daily plus ASA 100 mg/day.
- Outcomes included stroke, cardiovascular death, and complications related to peripheral artery disease, such as lower extremity amputations.
Main Results:
- The combination of rivaroxaban and ASA significantly reduced the composite risk of stroke and cardiovascular death by 24%.
- Incidence of stroke decreased by 42%, and cardiovascular death by 22% in the combination group.
- Patients with peripheral artery disease experienced improved prognosis, with fewer amputations and major lower extremity complications.
Conclusions:
- Simultaneous modulation of platelet aggregation and coagulation pathways is effective in preventing atherothrombotic events in patients with stable atherosclerotic cardiovascular diseases.
- The COMPASS study demonstrated a significant benefit of adding low-dose rivaroxaban to ASA, particularly in high-risk patients including those with peripheral artery disease.
Abstract:
Despite obvious success in the management of patients with type 2 diabetes mellitus, incidence of myocardial infarction, stroke, critical ischemia, and lower extremity amputation remains high. Results of clinical studies of new hypoglycemic drugs have demonstrated their high efficacy in decreasing mortality, incidence of cardiovascular complications, and progression of chronic heart failure. At the same time, prevention of atherothrombotic complications is essential for this patient category. Traditionally, the antiaggregant therapy with acetylsalicylic acid (ASA) is administered to patients with stable atherosclerotic diseases to reduce the risk. Attempts of reducing additionally the risk with ASA combinations with other antiplatelet drugs did not produce an expected result. Theoretical prerequisites suggested that anticoagulant supplements would increase the treatment efficacy in prevention of atherothrombotic complications in patients with cardiovascular diseases. Recently emerged oral anticoagulants can be administered at a considerably lower dose. In the COMPASS study, a combination of rivaroxaban 2.5 mg twice a day and ASA 100 mg/day compared to ASA 100 mg/day significantly reduced the total risk of stroke and cardiovascular death by 24 % and incidence of stroke and cardiovascular death by 42% and 22 %, respectively. Patients with peripheral artery disease showed for the first time improvement of prognosis, decreased number of amputations, major complications of lower extremity disease. Results of the COMPASS study confirmed the validity of influencing simultaneously the platelet and the coagulation components of hemostasis in patients with stable atherosclerotic cardiovascular diseases.
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