Data Management And Sharing System of China National Clinical Research Center for Neurological Diseases
Association Between Body Mass Index and Clopidogrel-Aspirin Efficacy Was Modified by Glycated Albumin Level
First author：Zimo Chen
Corresponding author：Yongjun Wang
essential_information
2020-06-16
Published articles
Journal：Aging
Publication type: Original Contributions
IF(IF): 5.515
PMID: 32544082 Link To Pubmed Full text Download
Background And Purpose
Subgroup analysis of CHANCE showed that high BMI level significantly affected the efficacy of dual anti-platelet therapy. However, the underlying mechanism is unclear. Some researches argued that this phenomenon may be due to elevated BMI reflecting a condition of underlying metabolism disorder, such as insulin resistance and diabetes which enhanced baseline platelet reactivity. while others determined that the loss of dual-antiplatelet efficacy in overweight/obese patients may be due to the insufficient drug dose. This study aims to estimate the modification effect of GA on the association between body mass index and clopidogrel-aspirin efficacy among patients with minor stroke and TIA.
Method
In Clopidogrel in High-Risk Patients with Acute Nondisabling Cerebrovascular Events trial, 3044 patients with available baseline GA were recruited. Low/normal weight and overweight/obesity were defined as BMI < 25 kg/m2 and ≥ 25 kg/m2, respectively. Elevated and low GA levels were defined as GA levels > 15.5 % and ≤ 15.5 %, respectively. The primary outcome was stroke recurrence during the 90-day follow-up.
Conclusion
Compared with aspirin alone, efficacy of clopidogrel-aspirin therapy for stroke still exists in overweight/obesity patients with normal glycemic control.
Main results
Patients with overweight/obesity and low GA levels still benefited from clopidogrel-aspirin therapy for stroke recurrence (Hazard ratio [HR]: 0.48, 95 % confidence interval [CI]: 0.28–0.82), so did those with high GA levels but low/normal weight (HR: 0.67, 95 % CI: 0.45–0.99). However, patients with both overweight/obesity and high GA levels did not benefit from clopidogrel-aspirin therapy (HR: 0.89, 95 % CI: 0.59–1.33).