Literature review

Antiplatelet Therapy in
Diabetes Mellitus Patients as
Primary Prevention of
Coronary Heart Disease
By : Baiq Denda Putria Ningsih
SPV : dr. Yusra Pintaningrum, Sp.JP(K), FIHA
 01
INTRODUTION
INTRODUCTION ● Despite advances in therapy, the diagnosis of diabetes mellitus
(DM) is associated with increased morbidity and decreased
quality of life.
● Diabetes mellitus prevalence tends to increase from year to year
both globally and in Indonesia.
● DM is a major risk factor for cardiovascular disease
● Coronary heart disease is the leading cause of death in the US
and worldwide.
● DM is associated with a 2 to 4-fold increased risk of dying from
heart disease
● Early to more severe vascular disease, as well as a
prothrombotic state, are key mechanisms that lead to vascular
deterioration in patients with diabetes mellitus. A prothrombotic
state occurs secondary to platelet hyperreactivation and
hypofibrinolysis.
INTRODUCTION
● Current treatment strategies for vascular repair in individuals with
DM have focused on revascularization of acute atherosclerotic
thrombotic occlusions, with early introduction of antithrombotic
therapy, usually with inhibition of platelet function as primary
prevention of coronary heart disease in diabetes mellitus.

● However, antiplatelet therapy in patients with diabetes mellitus

as primary prevention of coronary heart disease is still
controversial.
 02
LITERATURE REVIEW
 Definition and epidemiology of diabetes mellitus and
coronary heart disease

DIABETES CORONARY HEART

MELLITUS DISEASE
Coronary heart disease is a condition in which
Diabetes mellitus is a group of
there is an inadequate supply of blood and
metabolic diseases characterized by
oxygen to the myocardium which occurs due to
hyperglycemia that occurs due to
the formation of atherosclerotic plaques which
defects in insulin secretion, insulin
causes coronary artery occlusion and results in
action or both
an imbalance of oxygen supply and demand.
 PREVALENCE OF DIABETES MELLITUS
INDONESIA
GLOBAL
• prevalence of DM also
continued to increase
• Increase from year to from 5.7 in 2007 to 6.9%
year. or around 9.1 million
people in 2013
• IDF → 15 million adults
aged 20-79 years • IDF, 2017 → Indonesia
worldwide suffer from DM was ranked 6th in the
in 2015 world by the number of
MORTALITY diabetes as many as 10.3
•and the number is million people.
expected to increase to 642 Based on data from the Ministry of Health's
million by 2040 Registration Survey, it shows that DM is the •and the number is
number 3 cause of death in Indonesia with a expected to increase to
percentage of 6.7%, after stroke (21.1 %), 21.3 million people in
and coronary heart disease 12.9%. 2030
 PREVALENCE OF CORONARY HEARTH DISEASE
GLOBAL INDONESIA

• Riskesdes, 2013
• CAD is the leading cause of →prevalence of CAD
death in the US and was 1.5%
worldwide

• WHO, 2015 → 70% of

deaths in the world were
caused by non-communicable
diseases, 45% of which were
caused by heart and blood MORTALITY
vessel disease, namely 17.7
million of the 39.5 million
Indonesian Sample Registration System,
deaths.
CHD is the second highest cause of death
after stroke, which is 12.9% of all causes of
death in Indonesia
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 02 04
CONTENTS Discussion Treatment
Here you could describe Here you could describe
the topic of the section the topic of the section

01 03 05
About the Patient Diagnosis Monitoring
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the topic of the section the topic of the section the topic of the section
 Definition and epidemiology of diabetes mellitus and
coronary heart disease

MARS JUPITER SATURN

Diabetes mellitus is a group of
metabolic diseases characterized by
hyperglycemia that occurs due to
defects in insulin secretion, insulin
action or both
It’s a gas giant and the Saturn is composed
biggest planet in the Solar mostly of hydrogen and
System also helium
 PATIENT MEDICAL HISTORY

Despite being red, Mars is

2010 actually a cold place

Mercury is the closest

planet to the Sun 2012

AGE 62 Saturn is composed of

2018 hydrogen and helium
GENDER Male

ALLERGIES None Jupiter is the biggest

planet of them all 2019
LOCATION Barcelona
 REVIEW OF SYSTEMS

Mercury is the closest planet

to the Sun

● Here you can list the symptoms

observed in the patient
● Here you can list the symptoms
observed in the patient
● Here you can list the symptoms
observed in the patient
● Here you can list the symptoms
observed in the patient
 PHYSICAL EXAMINATION

SATURN
Saturn is composed
mostly of hydrogen
and helium MARS
Despite being red, this
planet is actually a cold
JUPITER place
It’s a gas giant and the
biggest planet in the
Solar System
A PICTURE IS
WORTH A
THOUSAND
WORDS
 PREVALENCE

SATURN MARS
It’s actually a
It’s a gas giant and
cold place
has rings

VENUS
This planet has a
beautiful name
 PERCENTAGES

20%
60% 20%

Saturn is a gas giant Jupiter is the biggest Mars is full of iron

and has rings planet of them all oxide dust
8,987
Number of patients successfully
treated last year
 DISCUSSION
SUMMARY

Mercury is the closest planet to the

Sun and the smallest one in the Solar
System—it’s only a bit larger than the
Moon. The planet’s name has nothing
to do with the liquid metal, since
Mercury was named after the Roman
messenger god
 COMPARISON

JUPITER MERCURY VENUS MARS

FACTOR 1

FACTOR 2

FACTOR 3
 DIAGNOSIS

MERCURY VENUS MARS

Mercury is the closest Venus is the second planet Despite being red, Mars is
planet to the Sun from the Sun actually a cold place

JUPITER SATURN NEPTUNE

Jupiter is the biggest It’s composed mostly of Neptune is the farthest
planet of them all hydrogen and helium planet from the Sun
 TREATMENT

MERCURY MARS SATURN NEPTUNE

Mercury is the Despite being red, It’s composed mostly Neptune is the
closest planet Mars is actually a of hydrogen and farthest planet from
to the Sun cold place helium the Sun
PATIENT MONITORING

Venus has a beautiful name Saturn is the ringed one

Despite being red, Mars is cold

Week 1
Week 2
33% 20% 47% Week 3
 CONTRAINDICATIONS AND INDICATIONS

WHY YOU SHOULD STOP THE WHY YOU SHOULD START THE
TREATMENT TREATMENT

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treatment
● Here you can describe a reason to stop the
treatment
● Here you can describe a reason to stop the
treatment
● Here you can describe a reason to stop the
treatment
● Here you can describe a reason to start the
treatment
● Here you can describe a reason to start the
treatment
● Here you can describe a reason to start the
treatment
● Here you can describe a reason to start the
treatment
 POST-PREVENTION

MARS NEPTUNE
Despite being red, Mars is Neptune is the farthest
actually a cold place planet from the Sun

VENUS MERCURY
Venus is the second planet Mercury is the closest
from the Sun planet to the Sun
 CASE TIMELINE

WEEK 1 WEEK 3
Venus has a beautiful Jupiter is the biggest
name planet

WEEK 2 WEEK 4
Mars is full of iron Pluto is a dwarf planet
oxide dust
 CONCLUSIONS

Jupiter is a gas giant, the biggest planet in the

Solar System and the fourth-brightest object in
the night sky. It’s named after the Roman god of
the skies and lightning. It’s composed mainly of
hydrogen and helium
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