Soluble urokinase plasminogen activator receptor (suPAR) is a new biomarker of systemic chronic inflammation strongly associated with the presence and incidence of diabetes, cardiovascular disease, venous thrombosis, and mortality1., 2., 3., 4., 5., 6.; as well as with development of complications in type 1 diabetes.7 Recently, results have implied a causal link between suPAR and atherosclerosis8 and suPAR have been suggested to interact with factors involved in platelet aggregation and fibrinolysis.9,10 But its role in thrombotic processes have yet to be defined.

The process of platelet adhesion and aggregation is complex and involves the simultaneous activation of several factors in response to inflammatory signals.11,12 Increased platelet aggregation has been linked with disorders with high cardiovascular risk, such as type 2 diabetes, and liver disease.13,14 Furthermore, higher platelet aggregation affinity has been suggested to directly facilitate development of atherosclerosis in animal models,12 but the mechanisms remain unclear and chronic inflammation, evaluated using suPAR, might be a possible causal link. Additionally, recent studies have demonstrated that maximal carotid plaque thickness (cPTmax), measured by ultrasound, is a far better predictor of future cardiovascular events than the more commonly used carotid intima media thickness, and on par with established computer tomography measures such as the coronary artery calcification score.15., 16., 17.

Type 1 and type 2 diabetes are two conditions both characterized by a high degree of systemic vascular damage and systemic chronic inflammation, leading to a high risk of cardiovascular disease.18,19 However, there are radical differences in the path of the progression of complications across diabetes types20., 21., 22. making it important to discriminate between the two. We therefore set out to investigate the associations between suPAR, platelet aggregation, and cPTmax, in a post hoc analysis of two cross-sectional studies including participants with type 1 and type 2 diabetes.