Effects of Ramadan fasting on aspirin resistance in type 2 diabetic patients

AimsRamadan fasting (RF) may affect aspirin resistance. We conducted this study in patients with cardiovascular risk (CVR) factors to assess the effect of RF on aspirin resistance and explore whether type 2 diabetes mellitus (DM) would influence this effect.MethodsA total of 177 stable patients with ≥2 CVR factors were recruited. All patients observed RF and were taking aspirin. Physical exam and standard biological tests including glycaemia and serum lipids data were performed before Ramadan (Pre-R), at the last week of Ramadan (R) and four weeks after the end of Ramadan (Post-R). In the same visits caloric intake was calculated and platelet reactivity to aspirin was assessed using Verify Now point-of-care assay.ResultsIn the overall population, there was no significant change in absolute aspirin reaction unit (ARU) values and in metabolic parameters. In DM patients (n = 127), ARU change from Pre-R values was+19.7 (p = 0.01) and +14.4 (p = 0.02) respectively at R and Post-R. During Ramadan, glycaemia, triglycerides, and cholesterol levels increased significantly and returned to Pre-R values thereafter. These changes were not observed in non-DM patients.ConclusionsDuring RF aspirin resistance increased only in DM patients. This effect persisted one month after Ramadan. Simultaneous alteration of glycemic control and increase of serum lipids levels could potentially be a favorable factor.Study registrationThe protocol was registered at clinicaltrials.gov under: NCT02720133.【研究目的】斋月斋戒（Ramadan fasting, RF）可能影响阿司匹林抵抗。本研究纳入合并心血管风险因素的患者，旨在评估斋月斋戒对阿司匹林抵抗的作用，并探讨2型糖尿病（type 2 diabetes mellitus, DM）是否会对该效应产生影响。 【研究方法】本研究共纳入177例合并至少2项心血管风险（cardiovascular risk, CVR）因素的稳定患者。所有患者均参与斋月斋戒且规律服用阿司匹林。分别于斋月斋戒前（before Ramadan, Pre-R）、斋月斋戒最后一周（last week of Ramadan, R）及斋月结束后4周（four weeks after the end of Ramadan, Post-R）完成体格检查及包括血糖、血脂数据在内的标准生物学检测。在每次随访时，均计算受试者的热量摄入情况，并采用Verify Now床旁检测（Verify Now point-of-care assay）评估血小板对阿司匹林的反应性。 【研究结果】在全部受试者中，绝对阿司匹林反应单位（absolute aspirin reaction unit, ARU）数值及代谢参数均无显著变化。在2型糖尿病患者（n=127）中，斋月斋戒最后一周及斋月结束后4周时，其绝对阿司匹林反应单位较斋月斋戒前分别升高19.7（p=0.01）及14.4（p=0.02）。斋月斋戒期间，受试者的血糖、甘油三酯及胆固醇水平均显著升高，后续恢复至斋月斋戒前水平。上述变化在非2型糖尿病患者中未出现。 【研究结论】仅在2型糖尿病患者中，斋月斋戒期间阿司匹林抵抗程度升高，且该效应在斋月结束1个月后仍持续存在。血糖控制异常与血脂水平升高共同存在，可能是该现象的潜在促成因素。 【研究注册】本研究方案已于临床试验.gov（clinicaltrials.gov）注册，注册号为NCT02720133。