Dipeptidyl peptidase-IV in chronic heart failure with reduced ejection fraction. (15th August 2017)

• Record Type: Journal Article
• Authors: Lourenço, Patrícia; Silva, Sérgio; Cunha, Filipe; Pereira, Joana; Ribeiro, Ana; Silva, Nuno; Guimarães, João Tiago; Araújo, José Paulo; Bettencourt, Paulo
• Is Part Of: International journal of cardiology. Volume 241(2017)
• Page Start: 249
• Page End: 254
• Publication Date: 2017-08-15
• Subjects: Chronic heart failure -- Dipeptidyl peptidase-IV -- Prognosis; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2017.03.042
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Background: An association between dipeptidyl peptidase-IV (DPP-IV) inhibitors with worse prognosis in HF has been suggested. We aimed to assess the serum DPP-IV levels in chronic stable HF patients and determine their association with prognosis. Methods and results: Chronic stable HF patients with optimized prognostic-modifying therapy were prospectively recruited. Exclusion criteria: 1) ejection fraction > 50%, 2) hospitalizations or therapeutic adjustments in the previous 2 months; 3) patients on renal replacement therapy, and 4) use of DPP-IV inhibitors. A fasting venous blood sample was collected and DPP-IV was measured. Patients were followed-up for 3 years and the endpoint studied was all-cause death. Patients' characteristics were compared according to DPP-IV quartiles. A Cox regression analysis was performed and multivariate models were built. The 3rd DPP-IV quartile was the reference category. We studied 264 patients. Mean age: 69 (± 13) years, 70.5% were male and 33.7% diabetic. Median (IQR) serum DPP-IV levels were 455.6 (350.0–625.5) ng/mL. DPP-IV had an inverse relationship with age. Patients in 3rd DPP-IV quartile were in lower NYHA classes and had the lowest 3 years all-cause mortality. Patients in the 1st DPP-IV quartile had a multivariate adjusted HR of 3-year mortality of 2.62 (95%CI: 1.15–5.95) when compared with reference category and the HR for the 4th quartile was of 3.79 (95%CI: 1.68–8.54). Conclusions: There is a U-shaped association of serum DPP-IV with mortality in chronic systolic HF patients. Patients in the 3rd DPP-IV quartile have the best multivariate adjusted 3-year survival. DPP-IV inhibition might be harmful in patients with low DPP-IV.