Mean platelet volume and long-term cardiovascular outcomes in patients with type 2 diabetes mellitus.

Background: Altered platelet function contributes to the prothrombotic state in type 2 diabetes mellitus (DM), potentially influencing long-term cardiovascular risk. Mean platelet volume (MPV), a readily available marker of platelet size and activity, has been linked to adverse cardiovascular outcomes, yet its prognostic value in DM is less defined. This study evaluated the association between MPV and the composite MPV × platelet count (MPV × PLT) with long-term cardiovascular outcomes in patients with DM without prior myocardial infarction (MI) or stroke. Methods: This retrospective cohort study used anonymized data from 88,710 patients with DM and no prior history of MI or stroke. Patients were classified into three equal-sized groups based on MPV and MPV*PLT values, with additional analysis of the lowest and highest 5 % of values. The primary outcome was major adverse cardiac and cerebrovascular events (MACCE), a composite of all-cause mortality, MI, and stroke. Results: During a median follow-up of 8.9 years, a total of 8,828 (10.0 %) MACCE events occurred. MACCE rates were highest in the lowest (13.1 %) and highest (10.0 %) MPV groups (p < 0.001). Both low and high MPV × PLT values were independently associated with greater MACCE risk versus the middle group (adjusted hazard ratio 1.22, 95 % CI 1.11-1.33; and hazard ratio 1.47, 95 % CI 1.33-1.63; both p < 0.001). Conclusions: Extreme MPV and MPV × PLT values were independently associated with adverse long-term cardiovascular outcomes in patients with DM. These findings suggest that MPV and MPV × PLT may serve as cost-effective, readily available biomarkers for improving cardiovascular risk stratification in this high-risk population.