Effect of Dipeptidyl Peptidase-4 Inhibitor on All-Cause Mortality and Coronary Revascularization in Diabetic Patients.
10.4250/jcu.2015.23.4.233
- Author:
Hyo Eun PARK
1
;
Jooyeong JEON
;
In Chang HWANG
;
Jidong SUNG
;
Seung Pyo LEE
;
Hyung Kwan KIM
;
Goo Yeong CHO
;
Dae Won SOHN
;
Yong Jin KIM
Author Information
1. Division of Cardiology, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Korea.
- Publication Type:Multicenter Study ; Original Article
- Keywords:
Dipeptidyl peptidase-4 inhibitor;
Mortality;
Cardiovascular outcome;
Computed tomography
- MeSH:
Atherosclerosis;
C-Reactive Protein;
Calcium;
Cohort Studies;
Constriction, Pathologic;
Coronary Stenosis;
Coronary Vessels;
Diabetes Mellitus;
Hemoglobin A, Glycosylated;
Humans;
Hydroxymethylglutaryl-CoA Reductase Inhibitors;
Hypertension;
Mortality*;
Retrospective Studies
- From:Journal of Cardiovascular Ultrasound
2015;23(4):233-243
- CountryRepublic of Korea
- Language:English
-
Abstract:
BACKGROUND: Anti-atherosclerotic effect of dipeptidyl peptidase-4 (DPP-4) inhibitors has been suggested from previous studies, and yet, its association with cardiovascular outcome has not been demonstrated. We aimed to evaluate the effect of DPP-4 inhibitors in reducing mortality and coronary revascularization, in association with baseline coronary computed tomography (CT). METHODS: The current study was performed as a multi-center, retrospective observational cohort study. All subjects with diabetes mellitus who had diagnostic CT during 2007-2011 were included, and 1866 DPP-4 inhibitor users and 5179 non-users were compared for outcome. The primary outcome was all-cause mortality and secondary outcome included any coronary revascularization therapy after 90 days of CT in addition to all-cause mortality. RESULTS: DPP-4 inhibitors users had significantly less adverse events [0.8% vs. 4.4% in users vs. non-users, adjusted hazard ratios (HR) 0.220, 95% confidence interval (CI) 0.102-0.474, p = 0.0001 for primary outcome, 4.1% vs. 7.6% in users vs. non-users, HR 0.517, 95% CI 0.363-0.735, p = 0.0002 for secondary outcome, adjusted variables were age, sex, presence of hypertension, high sensitivity C-reactive protein, glycated hemoglobin, statin use, coronary artery calcium score and degree of stenosis]. Interestingly, DPP-4 inhibitor seemed to be beneficial only in subjects without significant stenosis (adjusted HR 0.148, p = 0.0013 and adjusted HR 0.525, p = 0.0081 for primary and secondary outcome). CONCLUSION: DPP-4 inhibitor is associated with reduced all-cause mortality and coronary revascularization in diabetic patients. Such beneficial effect was significant only in those without significant coronary stenosis, which implies that DPP-4 inhibitor may have beneficial effect in earlier stage of atherosclerosis.
