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Effect of sarpogrelate, a selective 5-HT2A receptor antagonist, on characteristics of coronary artery disease in patients with type 2 diabetes

  • Dong-Hwa Lee
    Affiliations
    Department of Internal Medicine, Seoul National University College of Medicine and Seoul National University Bundang Hospital, Seongnam, South Korea
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  • Eun Ju Chun
    Affiliations
    Department of Radiology, Seoul National University College of Medicine and Seoul National University Bundang Hospital, Seongnam, South Korea
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  • Jee Hye Hur
    Affiliations
    Department of Radiology, Seoul National University College of Medicine and Seoul National University Bundang Hospital, Seongnam, South Korea
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  • Se Hee Min
    Affiliations
    Department of Internal Medicine, Seoul National University College of Medicine and Seoul National University Bundang Hospital, Seongnam, South Korea
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  • Jie-Eun Lee
    Affiliations
    Department of Internal Medicine, Seoul National University College of Medicine and Seoul National University Bundang Hospital, Seongnam, South Korea
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  • Tae Jung Oh
    Affiliations
    Department of Internal Medicine, Seoul National University College of Medicine and Seoul National University Bundang Hospital, Seongnam, South Korea
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  • Kyoung Min Kim
    Affiliations
    Department of Internal Medicine, Seoul National University College of Medicine and Seoul National University Bundang Hospital, Seongnam, South Korea
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  • Hak Chul Jang
    Affiliations
    Department of Internal Medicine, Seoul National University College of Medicine and Seoul National University Bundang Hospital, Seongnam, South Korea
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  • Seung Jin Han
    Affiliations
    Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, South Korea
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  • Doo Kyoung Kang
    Affiliations
    Department of Radiology, Ajou University School of Medicine, Suwon, South Korea
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  • Hae Jin Kim
    Correspondence
    Corresponding author. Department of Endocrinology and Metabolism, Ajou University School of Medicine, 164 Word Cup-ro, Yeongtong-gu, Suwon, 443-380, South Korea.
    Affiliations
    Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, South Korea
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  • Soo Lim
    Correspondence
    Corresponding author. Department of Internal Medicine, Seoul National University College of Medicine and Seoul National University Bundang Hospital, 173-82 Gumi-ro, Bundang-gu, Seongnam, 463-707, South Korea.
    Affiliations
    Department of Internal Medicine, Seoul National University College of Medicine and Seoul National University Bundang Hospital, Seongnam, South Korea
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      Highlights

      • Sarpogrelate, a selective 5-HT2A receptor antagonist, reduced coronary artery plaque volume significantly in patients with type 2 diabetes.
      • Regression of atheroma was more prominent in noncalcified plaque than in calcified plaque.
      • These beneficial effects are attributable to the pleiotropic properties including its anti-inflammatory and insulin-sensitizing properties.

      Abstract

      Background and aims

      Sarpogrelate, a 5-hydroxytryptamine type 2A antagonist, is a potential antiplatelet agent. We performed a randomized study to evaluate the effect of sarpogrelate on vascular health in Korean patients with diabetes.

      Methods

      Forty diabetic patients aged 58.6 ± 6.8 years with 10–75% coronary artery stenosis, as assessed by coronary computed tomography angiography, were randomly assigned to sarpogrelate 300 mg/day plus aspirin 100 mg/day (SPG + ASA group) or aspirin 100 mg/day alone (ASA group) for 6 months. The primary endpoint of this study was the change in coronary artery disease including the calcium score (CACS), maximal stenosis, and plaque volume (calcified vs. noncalcified). The secondary endpoints were changes in biochemical parameters related to glucose and lipid metabolism, and in subclinical atherosclerosis assessed by ankle–brachial index and pulse wave velocity.

      Results

      After 6-month treatment, there was no significant difference in the changes in CACS, coronary stenosis, ankle–brachial index, and pulse wave velocity, between groups. The total plaque volume decreased from 82.4 ± 14.5 mm3 to 74.6 ± 14.4 mm3 in the SPG + ASA group, but increased from 64.9 ± 16.0 mm3 to 68.6 ± 16.3 mm3 in the ASA group (p < 0.05), mainly driven by changes in the noncalcified component (SPG + ASA group 15.6 ± 4.6 mm3 to 11.2 ± 3.7 mm3 vs. ASA group 21.2 ± 6.2 mm3 to 22.8 ± 6.6 mm3, p < 0.01). Serum C-reactive protein levels and homeostasis model assessment of insulin resistance tended to decrease in the SPG + ASA group, but they were not altered in the ASA group.

      Conclusions

      The present study demonstrated that sarpogrelate treatment may decrease coronary artery plaque volume, particularly the noncalcified portion, in patients with diabetes.

      Keywords

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