Dipeptidyl Peptidase‐4 Inhibitors and Cardiovascular Outcomes: Meta‐Analysis of Randomized Clinical Trials with 55, 141 Participants. Issue 4 (August 2014)

• Record Type: Journal Article
• Authors: Wu, Shiying; Hopper, Ingrid; Skiba, Marina; Krum, Henry
• Is Part Of: Cardiovascular therapeutics. Volume 32:Issue 4(2014:Aug.)
• Page Start: 147
• Page End: 158
• Publication Date: 2014-08
• Subjects: Cardiovascular pharmacology -- Periodicals; Cardiovascular agents -- Periodicals; Cardiovascular system -- Diseases -- Chemotherapy -- Periodicals; Cardiovascular Agents -- Periodicals; Cardiovascular Diseases -- drug therapy -- Periodicals; Agents cardiovasculaires -- Périodiques; Appareil cardiovasculaire -- Maladies -- Chimiothérapie -- Périodiques; 616.1005
• DOI: 10.1111/1755-5922.12075
• Languages: English
• ISSNs: 1755-5914

Abstract

<abstract abstract-type="main" id="cdr12075-abs-0001"> <title>Abstract</title> <sec id="cdr12075-sec-0001" sec-type="section"> <title>Aims</title> <p>The association between glucose lowering in diabetes mellitus and major cardiovascular (CV) outcomes is weak; indeed, some oral hypoglycemic agents are associated with increased CV events. Dipeptidyl peptidase‐4 inhibitors (DPP‐4 inhibitors) are a new class of oral hypoglycemic agent that may have beneficial CV effects. We undertook a systematic review and meta‐analysis to appraise the CV safety and efficacy of DPP‐4 inhibitors.</p> </sec> <sec id="cdr12075-sec-0002" sec-type="section"> <title>Methods</title> <p>Comprehensive search for prospective trials involving DPP‐4 inhibitors. Trials included reported at least one of the outcomes examined, recruited minimum 100 patients and minimum follow‐up 24 weeks. The risk ratio (RR) was calculated using the Mantel–Haenszel random‐effects model for mortality and major cardiovascular (CV) outcomes.</p> </sec> <sec id="cdr12075-sec-0003" sec-type="section"> <title>Results</title> <p>Fifty trials enrolling 55, 141 participants were included. Mean follow‐up 45.3 weeks. DPP‐4 inhibitors compared with all comparators (placebo and active) showed no difference in all‐cause mortality (n = 50, 982, RR = 1.01, 95% CI 0.91–1.13, <italic>P</italic> = 0.83), CV mortality (n = 48, 151, RR = 0.97, 95% CI 0.85–1.11, <italic>P</italic> = 0.70), acute coronary syndrome (ACS) (n = 53, 034 RR = 0.97, 95% CI 0.87–1.08, <italic>P</italic> = 0.59), or stroke (n = 42, 737, RR = 0.98, 95% CI 0.81–1.18, <italic>P</italic> = 0.80), and a statistically significant increase in heart failure outcomes (n = 39, 953, RR = 1.16, 95% CI 1.01–1.33, <italic>P</italic> = 0.04).</p> </sec> <sec id="cdr12075-sec-0004" sec-type="section"> <title>Discussion</title> <p>Treatment with DPP‐4 inhibitors compared with placebo shows no increase in risk with regards to all‐cause mortality, CV mortality, ACS, or stroke, but a statistically significant trend toward increased risk of HF outcomes.</p> </sec> <sec id="cdr12075-sec-0005" sec-type="section"> <title>Conclusion</title> <p>These findings suggest no cardiovascular harm (or benefit) with DPP‐4 inhibitors; further large‐scale CV outcome studies will resolve the issue of excess HF risk.</p> </sec> </abstract>