Aspirin and clopidogrel resistance in patients with diabetes mellitus.

We read with interest the review paper on aspirin and clopidogrel resistance by Wang et al.1 We agree that it is an emerging entity with important clinical implications. Nevertheless, we were surprised that very little emphasis was put on the antiplatelet agent resistance of diabetic patients. Only one short sentence mentioned that hyperglycaemia may decrease the effectiveness of antiplatelet therapy by increasing reactive oxidant species. Still the specific case of diabetic patients is of major interest as diabetes mellitus, especially type 2 diabetes, is an increasing cause of cardiovascular disease worldwide. Antiplatelet therapy is a cornerstone in the prevention and treatment of cardiovascular disease in any at-risk individual, including patients with diabetes. However, recent observations showed that patients with diabetes may show both acetylsalicylic acid (aspirin)2 and clopidogrel3 resistance.