Ticagrelor – is it effective in preventing major cardiac events in patients with diabetes and coronary artery disease?

This study investigated ticagrelor (Brilique) added to aspirin in patients with coronary artery disease (CAD) and diabetes mellitus (DM). 

They found that ticagrelor reduced the risk of cardiac events in these patients. 

Patients with diabetes have a higher risk of ischemic events (IEs). IEs are caused by a lack of oxygen due to reduced blood flow. Coronary artery disease (CAD) can lead to IEs due to blockages in blood vessels. A procedure called percutaneous coronary intervention (PCI) is used to restore blood flow. 

Patients with diabetes and CAD have a high risk of IEs. To reduce the risk of IEs patients are given anti-platelet therapy (APT). Platelets are cells in the blood that cause clotting. APT reduces the risk of clotting and blockages. Aspirin is the most commonly used APT. Ticagrelor is another APT. Combining APT drugs has proven effective in CAD patients. It is unclear if ticagrelor and aspirin combination is more effective than aspirin alone in patients with diabetes and CAD. 

This study included 11,154 DB-CAD patients. All patients had a history of PCI. Patients were randomly assigned to ticagrelor (90 mg, twice daily) or placebo (inactive tablet). All patients also took aspirin (75-150 mg/day). After approximately 1 year, the ticagrelor dose was adjusted to 60 mg, twice daily. The main outcome was cardiovascular death (CVD), heart attack and/or stroke.

The risk of CVD, heart attack and stroke was 15% lower in ticagrelor-treated patients who have had a PCI. Ticagrelor was associated with a reduced risk of a type of heart attack called ST-elevation myocardial infarction MI (STEMI).

There was a 2-fold higher risk of major bleeding in patients taking ticagrelor. The risk of fatal bleeding was similar between patients taking ticagrelor and those taking placebo. When safety and effectiveness outcomes were combined, the net clinical benefit for ticagrelor + aspirin was 15% higher than aspirin only. 

The authors concluded that ticagrelor added to aspirin reduced the risk of cardiac events in patients with diabetes and CAD.

Patients in this study were not at the highest risk of IEs. More studies are needed. This study received funding from AstraZeneca, the manufacturer of ticagrelor.

If you have any concerns regarding CAD please discuss this with your physician.