|Year : 2019 | Volume
| Issue : 3 | Page : 949-954
Mean platelet volume and its correlation with cardiovascular risk in type 2 diabetic patients
Nabil A El-Kafrawy1, Mohamed A El-Said1, Mohamed A Abd El-Hafeez2, Heba Adel Saleh Omar Saeed3
1 Department of Internal Medicine, Faculty of Medicine, Menoufia University, Shebeen El-Kom, Egypt
2 Department of Hematology, Faculty of Medicine, Menoufia University, Shebeen El-Kom, Egypt
3 Internal Medicine at Ministry of Health, Alexandria, Egypt
|Date of Submission||10-Mar-2018|
|Date of Acceptance||21-May-2018|
|Date of Web Publication||17-Oct-2019|
Heba Adel Saleh Omar Saeed
Internal Medicine, Ministry of Health, Alexandria
Source of Support: None, Conflict of Interest: None
To evaluate the mean platelet volume (MPV) and its correlation with cardiovascular risk in type 2 diabetic patients.
Platelet functions have important roles in the development of vascular complications in diabetic patients. Platelets with increased volume have increased activity compared to smaller ones, therefore, MPV is used as a marker for platelet activity.
Patients and methods
A cross-sectional analytical study was done on a group of 60 type 2 diabetic patients divided into group I, included 23 cases without cardiovascular disease, group II, included 37 cases with cardiovascular disease, and group III, included 20 healthy people as the control group. All patients attended the Endocrine and Diabetes Clinic in Menoufia University during the period from 2015 to 2016. Comparisons of fasting blood sugar, 2-h post prandial (2HPP), lipid profile, and MPV were tested.
Diabetic patients with cardiovascular disease had a higher MPV (11.08 ± 1.39) than diabetic patients without cardiovascular disease (10.53 ± 1.33) and healthy group (8.30 ± 1.62). There was a significant difference between the studied groups regarding MPV, fasting blood sugar, 2HPP and low density lipoprotein cholesterol, and hemoglobin A1c. In addition, MPV showed a significant positive correlation with fasting blood sugar, 2HPP, hemoglobin A1c, serum cholesterol, and low density lipoprotein cholesterol. Whereas, MPV was not correlated with serum glyceride and high-density lipoprotein cholesterol.
Platelet dysfunction occurs in diabetic patients and this is demonstrated by higher than normal MPV. MPV was found to carry a risk of development of cardiovascular disease in these patients.
Keywords: cardiovascular disease, diabetes mellitus, diabetic complications, mean platelet volume
|How to cite this article:|
El-Kafrawy NA, El-Said MA, Abd El-Hafeez MA, Omar Saeed HA. Mean platelet volume and its correlation with cardiovascular risk in type 2 diabetic patients. Menoufia Med J 2019;32:949-54
|How to cite this URL:|
El-Kafrawy NA, El-Said MA, Abd El-Hafeez MA, Omar Saeed HA. Mean platelet volume and its correlation with cardiovascular risk in type 2 diabetic patients. Menoufia Med J [serial online] 2019 [cited 2020 Feb 27];32:949-54. Available from: http://www.mmj.eg.net/text.asp?2019/32/3/949/268801
| Introduction|| |
Diabetes is one of the largest global health emergencies of the 21st century. The number of people developing this condition is increasing dramatically. In addition to the 415 million adults who are estimated to currently have diabetes, there are 318 million adults with impaired glucose tolerance, and that puts them at high risk of developing the disease in future . Type 2 diabetes mellitus (DM) is both metabolic disorder and major worldwide health problem because of its high prevalence and morbidity . Type 2 DM is a part of the metabolic syndrome that consists of dyslipidemia, hypertension, impaired fibrinolysis, and increased procoagulation factors . Vascular disorder such as coronary artery disease enhances the morbidity and mortality of type 2 DM. Type 2 DM induces atherosclerosis, circulation dysfunction, and dysregulation of coagulation . It is reported that cardiovascular mortality risk is correlated with blood glucose concentration in cases with type 2 DM . Hyperglycemia is thought to have a harmful effect on the blood vessels . Platelets are involved in homeostatic process and have an important role in atherosclerosis and arterial thrombosis. When vascular injury occurs, platelets adhere to the damaged endothelium to form a platelet plug . Platelet volume is a marker of platelet function and activation. It can be quantified as mean platelet volume (MPV) by clinical hematology analyzers. It has been reported that platelets from diabetic patients synthesize more thromboxane than normal platelets . It is found that hyperglycemia causes larger platelets. Larger platelets also release more prothrombotic factors such as thromboxane A2 . It is also suggested that the increased platelet activity enhances vascular complications in these patients. In addition, it is revealed that increased MPV plays a role in myocardial infarction, thromboembolism, and stroke. The prevalence of cardiovascular complication in type 2 DM may be associated with HbA1c and MPV . In patients with diabetes, MPV was found higher when compared to normal glycemic controls, and previous studies demonstrated that poor glycemic control and an increase in MPV may play a role in the microvascular and macrovascular complications related to diabetes . Demirtunc et al.  suggested that increased HbA1c level was associated with increased MPV. They also proposed that ameliorated glycemic control decreases MPV and avoids the possible role of platelets in cardiovascular risks in type 2 DM . In another study, it was shown that HbA1c and diabetes duration have individually induced cardiovascular adverse effects in adolescents with type 2 DM . However, Hekimsoy et al.  did not find any correlation between MPV and FSG in patients with type 2 DM . Therefore, the aim of this study was to evaluate MPV and its correlation with the cardiovascular risk in type 2 diabetic patients.
| Patients and Methods|| |
A cross-sectional analytical study was conducted on 60 diabetic patients regularly coming for management and follow-up at the Diabetic Clinic in Menoufia University and 20 healthy persons as the control group. Cases were selected during the study period from 2015 to 2016; all study participants were divided into three groups:
- Group I: the group included 23 type 2 diabetic patients without cardiovascular disease (10 males and 13 females)
- Group II: the group included 37 type 2 diabetic patients with cardiovascular disease (23 males and 14 females)
- Group III: the group included 20 healthy participants (12 male and eight female) who were clinically free and volunteered to participate in the study.
The study was approved by the Ethical Committee of Menoufia Faculty of Medicine and an informed consent obtained from all participant's guardian before the study was commenced.
Selection criteria for the patients
The participants included in this study were selected according to the inclusion and exclusion criteria.
Type 2 diabetics above 40 years old.
Patients with type 1 diabetes, hematological diseases, collagenic diseases, renal and liver insufficiency diseases, infection, and patients receiving cytotoxic drugs and other drugs that alter the platelet level, malignancy, pregnancy, and preeclampsia.
Method of sampling
Sample size was calculated using the computer sample block randomization type. The samples were obtained during routine investigations. Five milliliter samples of venous blood were drained by sterile syringes, put in a tube containing dipotassium EDTA reagent, and the samples were then shaken gently and analyzed by Medonic 20 (Boule Diagnostics AB Domnarvsgatan 4, SE-163 53 Spånga, Sweden).
All cases were subjected to the following:
- Complete history: it included duration of diabetes, family history of diabetes, age at onset, history of micro/macrovascular complications, antidiabetic drugs, medications affecting the platelet function, and history of hematological and collagenic diseases
- Clinical examination: general examination includes anthropometric measurements such as height, weight, and body mass index (BMI). Local examination includes cardiovascular system (CVS), central nervous system (CNS), abdominal, and chest
- Laboratory investigations:
- Complete blood count: it includes total leucocyte count (103), platelet count, and hemoglobin level using Sysmex KX-21 automatized hematology analyzer (Sysmex Corporation, Wakinohama Kaigan-dori, Chuo-ku, Kobe, Hyogo, Japan)
- Lipid profile: it includes cholesterol, triglycerides, low density lipoprotein (LDL), high-density lipoprotein (HDL) using the open system autoanalyzer synchron, CX5 (Beckman, Chestnut street, Philadelphia, USA)
- Fasting blood glucose and 2-h post prandial (2HPP) blood glucose: it was measured using Sysmex KX-21 automatized hematology analyzer (Sysmex Corporation).
- Echocardiogram was done for all participants under study (Echocardiography; Echo Inc., USA).
The results were tabulated and statistically analyzed by using a personal computer using Microsoft Excel 2016 and SPSS, version 21 (SPSS Inc., Chicago, Illinois, USA). Statistical analysis was done using the descriptive: for example percentage, mean and SD and analytical: for example one-way analysis of variance test (F-test), Student's t-test, and Pearson correlation test (r) methods to study the relationship between the studied variables. A value of P less than 0.05 was considered statistically significant.
| Results|| |
The results showed that the age of group I patients ranged from 40 to 63 years, with mean of 51.6 ± 5.98, and in group II, the age ranged from 41 to 64, with mean of 52.17 ± 6.25, whereas in the control group, the age ranged from 40 to 65, with mean of 53.22 ± 10.04. In addition to this, 10 (43.5%), 23 (62.2%), and 12 (60%) patients from group I, II, and III were males, respectively, whereas the remaining were females. Furthermore, age of onset ranged from 27 to 55, with mean of 40.15 ± 6.68 years. Duration of diabetes ranged from 9 to15, with mean of 12.02 ± 2.15. More than half of the patients (55%) had no family history of Diabetes Mellitus. There were no statistical significant differences (P > 0.05) between the studied groups in terms of age, sex, age of onset, duration of diabetes, and family history for diabetes [Table 1].
|Table 1: Comparison between the three studied groups regarding age, sex, duration of diabetes, and family history for diabetes|
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The current study shows that there a was significant difference (P < 0.001) between the three studied groups regarding fasting blood sugar (FBS), 2HPP, and LDL cholesterol, which increased in group II (151.16 ± 35.8, 278.78 ± 29.61, 197.97 ± 54.96) than in group I (138.11 ± 41.6, 236.03 ± 43.61, 182.65 ± 41.92) and controls (91.55 ± 7.03, 131.20 ± 10.87, 92.70 ± 6.47), respectively. In addition to this, there was statistically significant difference between the studied groups regarding hemoglobin A1c (HbA1c) (P = 0.007), MPV (P = 0.026), serum cholesterol (P = 0.027), and P-selectin (P = 0.016), which increased significantly in group II (8.11 ± 0.56, 246.39 ± 29.44, 11.08 ± 1.39, 120.31 ± 19.19) than in group I (244.51 ± 30.24, 10.53 ± 1.33, 8.01 ± 0.70, 108.47 ± 6.73) and controls (5.06 ± 0.37, 8.30 ± 1.62, 161.65 ± 29.04, 92.70 ± 6.47, 80.3 ± 11.62). On the other hand, there was no statistically significant difference regarding serum triglyceride (P = 0.116) and HDL cholesterol (P = 0.58) [Table 2].
|Table 2: Comparison between different groups according to laboratory parameters|
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In addition to this, the current study shows that among the studied patients, MPV was significantly positively correlated with FBS (r = 0.326, P = 0.003), 2HPP, (r = 0.468, P < 0.001), HA1c (r = 0.463, P < 001), serum cholesterol (r = 0.539, P < 0.001), and LDL cholesterol (r = 0.452, P < 0.001). However, there was no significant correlation between MPV with serum glyceride (r = 0.139, P = 0.217) and HDL cholesterol (r = 0.046, P = 0.687) [Table 3].
|Table 3: Pearson correlation (r) between mean platelet volume and laboratory parameters|
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Furthermore, there was significant positive correlation between P-selectin and serum cholesterol, LDL cholesterol, FBS, 2HPP, and HbA1c [Table 4].
|Table 4: Pearson correlation (r) between mean platelet volume, P-selectin, and blood glucose level and hemoglobin A1c|
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| Discussion|| |
The aim of the study was to evaluate MPV and its correlation with cardiovascular risk in type 2 diabetic patients. The current study was conducted in 60 type 2 diabetic patients divided into group I, that included 23 cases without cardiovascular disease, group II, that included 37 cases with cardiovascular disease, and group III, that included 20 healthy people as the control group.
The results showed that there was no statistically significant difference between the studied groups regarding age, sex, age of onset, duration of diabetes, and family history for diabetes. However, there was a statistically significant difference between the three studied groups regarding FBS, 2HPP, and LDL cholesterol, which increased in group II than in group I and controls. In agreement with our study, Kemal et al.  found that there was no significant difference among the diabetic and nondiabetic groups for demographic characteristics of study participants, including age, BMI, and diabetes duration. In addition to this, Thomas et al.  found that the mean FBS level in the diabetic population was 150.5 ± 71.7 mg/dl, whereas that of the nondiabetic group was 78.56 ± 13.15 mg/dl. The mean postprandial blood sugar (PPBS) level in the diabetic population was 252.9 ± 94.85 mg/dl, whereas that of the nondiabetic group was 133.4 ± 56.75 mg/dl. The mean HbA1c level in the diabetic group was 9.13 ± 2.53%, as compared to 5.95 ± 0.723% in the nondiabetic group.
In our study, the mean platelet count in the diabetic group was higher than that of the nondiabetic group, that was similar to the studies done by Demirtunc et al.  and Zuberi et al. . Other studies by Hekimsoy et al.  had observed the opposite finding with lower platelet counts in the diabetic group compared with the nondiabetic healthy participants. Hence, the platelet count could be dependent on several variables, that is, mean platelet survival, platelet production rate, and turnover rate in DM. Also, in our study, the diabetic group had significantly higher MPV than the nondiabetic group. This agreed with the findings seen in studies done by Ateş et al.  and Papanas et al. .
In our study, higher values of MPV were observed in diabetic patients with cardiovascular disease. Higher values were also seen in the studies done by Ateş et al. . This suggested a role for the increased platelet activity in the pathogenesis of vascular complications. On the other hand, in the studies done by Hekimsoy et al.  and Demirtunc et al. , MPV was not significantly different in participants with diabetic neuropathy/retinopathy from that of diabetics without those complications. Their possible explanation was centered on the rapid consumption of activated platelets in diabetics with complications .
In our study, the diabetic group had significantly higher MPV than the nondiabeticgroup. This result is consistent with the other previous studies ,. However, Hekimsoy et al.  did not find any correlation between MPV and HbA1c levels. In the current study, MPV was statistically increased in diabetics with HbA1c levels at least 7% than in diabetics with HbA1c levels less than 7%. Recently, evidence has shown that P-selectin expressed on activated platelet contributes to the progression of atherosclerosis in ApoE-deficient mice. Hunter  reported that circulating-activated platelets and platelet-leukocyte/monocyte aggregates promote the formation of atherosclerotic lesions. They showed that the role of activated platelets in atherosclerosis is attributed to platelet P-selectin–mediated delivery of platelet-derived proinflammatory factors to monocytes/leukocytes and the vessel wall. Burger and Wagner  also performed bone marrow transplant experiments using ApoE-deficient and ApoE/P-selectin double-deficient mice to show the contribution of platelet P-selectin in the development of atherosclerotic lesion. However, no human studies have been reported examining the relation of platelet P-selectin with quantitatively determined atherosclerosis. In the Hidenori et al.  study, they examined the relation between platelet P-selectin and morphological and functional parameters of atherosclerosis in 517 Japanese participants. They found that platelet P-selectin expression was significantly and positively correlated with the arterial wall thickness and stiffness of the carotid arteries, with their associations independent of other clinical factors.
In our study, it is found that MPV is increased in type 2 DM, and we found that elevated HbA1c concentration and diabetes duration was directly correlated with increased MPV. In another study, it is shown that HbA1c and diabetes duration have individually induced cardiovascular adverse effects in adolescents with type 2 DM . However, Hekimsoy et al.  did not find any correlation between MPV and FSG in patients with type 2 DM; however, we found a correlation between MPV and FSG. Shimodaira et al.  also confirmed a relationship between MPV and FSG in prediabetic patients. Whereas, Kodiatte et al.  reported that increased platelet activity has an important role in the development of vascular complications in type 2 DM. It can be suggested that increased platelet volume may be an important factor in the enhanced risk of vascular complications in these cases. In this respect, MPV can be used as a favorable test in the monitoring type 2 DM in terms of atherosclerosis development.
| Conclusion|| |
Platelet dysfunction occurs in diabetic patients and that is demonstrated by higher than normal MPV. MPV was found to carry a risk of development of cardiovascular disease in these patients.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Nam H, David W, Nita F, Leonor G, Ian H, Rui L, et al
. International Diabetes Federation. Seventh edition, 2015; 12
Beckman JA, Creager MA, Libby P. Diabetes and atherosclerosis: epidemiology, pathophysiology, and management. JAMA 2002; 287
Colwell JA, Nesto RW. The platelet in diabetes: focus on prevention of ischemic events. Diabetes Care 2003; 26
Vericel E, Januel C, Carreras M, Moulin P, Lagarde M. Diabetic patients without vascular complications display enhanced basal platelet activation and decreased antioxidant status. Diabetes 2004; 53
Danaei G, Lawes CM, Vander Hoorn S, Murray CJ, Ezzati M. Global and regional mortality from ischaemic heart disease and stroke attributable to higher-than-optimum blood glucose concentration: comparative risk assessment. Lancet 2006; 368
Kaplan ZS, Jackson SP. The role of platelets in atherothrombosis. Hematology Am Soc Hematol Educ Program 2011; 2011
Sabuncu T. Mean platelet volume in various degrees of disturbed carbohydrate metabolism. Turk J Endocrinol Metabol 2012; 16
Han JY, Choi DH, Choi SW, Kim BB, Ki YJ, Chung JW, et al
. Stroke or coronary artery disease prediction from mean platelet volume in patients with type 2 diabetes mellitus. Platelets 2013; 24
Carson JL, Scholz PM, Chen AY, Peterson ED, Gold J, Schneider SH. Diabetes mellitus increases short-term mortality and morbidity in patients undergoing coronary artery bypass graft surgery. J Am Coll Cardiol 2002; 40
Demirtunc R, Duman D, Basar M, Bilgi M, Teomete M, Garip T. The relationship between glycemic control and platelet activity in type 2 diabetes mellitus. J Diabetes Complications 2009; 23
Imperatore G, Boyle JP, Thompson TJ, Case D, Dabelea D, Hamman RF, et al
. SEARCH for Diabetes in Youth Study Group. Projections of type 1 and type 2 diabetes burden in the U.S. population aged <20 years through 2050: dynamic modeling of incidence, mortality, and population growth. Diabetes Care. 2012; 35
Hekimsoy Z, Payzin B, Ornek T, Kandogan G. Mean platelet volume in type 2 diabetic patients. J Diabetes Complications 2004; 18
Kemal T, Recep D, Fatih S, Erhan Y, Ahmet T, Hatice R, et al
. Mean platelet volume in type 2 diabetes and atherosclerosis. Int J Clin Exp Med 2014; 7
Thomas A, Udaya K, Suraksha B, Thej M, Madhavi R, Harendra K, et al
. Mean platelet volume in type 2 diabetes mellitus. J Lab Physicians 2012; 4
Zuberi BF, Akhtar N, Afsar S. Comparison of mean platelet volume in patients with diabetes mellitus, impaired fasting glucose and non-diabetic subjects. Singapore Med J 2008; 49
Ateş O, Kiki I, Bilen H, Keleş M, Koçer I, Kulaçoglu DN, et al
. Association of mean platelet volume with the degree of retinopathy in patients with diabetes mellitus. Eur J Gen Med 2009; 6
Papanas N, Symeonidis G, Maltezos E, Mavridis G, Karavageli E, Vosnakidis T, et al
. Mean platelet volume in patients with type 2 diabetes mellitus. Platelets 2004; 15
Jindal S, Gupta S, Gupta R, Kakkar A, Singh HV, Gupta K, et al
. Platelet indices in diabetes mellitus: indicators of diabetic microvascular complications. Hematology 2011; 16
Hunter RW, Hers I. Insulin/IGF-1 hybrid receptor expression on human platelets: consequences for the effect of insulin on platelet function. J Thromb Haemost 2009; 7
Burger PC, Wagner DD. Platelet P-selectin facilitates atherosclerotic lesion development. Blood 2003; 101
Hidenori K, Takaaki M, Shinya F, Takuhito S, Takahisa Y, Yokoyama H et al
. Platelet P-selectin expression is associated with atherosclerotic wall thickness in carotid artery in humans. Circulation 2003; 108
Shah B, Sha D, Xie D, Mohler ER, Berger JS. The relationship between diabetes, metabolic syndrome, and platelet activity as measured by mean platelet volume: The National Health and Nutrition Examination Survey, 1999–2004. Diabetes Care 2015; 35
Shimodaira M, Niwa T, Nakajima K, Kobayashi M, Hanyu N, Nakayama T. Correlation between mean platelet volume and fasting plasma glucose levels in prediabetic and normoglycemic individuals. Cardiovasc Diabetol 2013; 12
Kodiatte T, Manikyam U, Rao S, Jagadish T, Reddy M, Lingaiah H, et al
. Mean platelet volume in type 2 diabetes mellitus. J Lab Physicians 2012; 4
[Table 1], [Table 2], [Table 3], [Table 4]