Abstract 16553: Cardiovascular Effects of Dipeptidyl Peptidase-4 Inhibitors in Diabetic Patients: A Meta-Analysis of 95 Trials
Introduction: Dipeptidyl peptidase-4 inhibitors (DPP-4) improve glucose control in patients with type 2 diabetes mellitus (DM), but their effects on cardiovascular (CV) events are debated.
Hypothesis: The aim of this study was to evaluate the impact of DPP-4 treatment on CV morbidity and mortality.
Methods: Randomized trials enrolling more than 200 patients, comparing DPP-4 inhibitors versus placebo or active treatments in patients with DM and reporting at least one adverse event among all-cause and CV mortality, stroke, myocardial infarction (MI) and new onset of heart failure (HF) were searched. Meta-analysis was performed to assess the influence of treatment on pre-specified outcomes in the short and long term (less and more than 30 weeks, respectively). The assumption of homogeneity between the treatment effects in different trials was tested by Q statistic and further quantified by I2 statistic. Macaskill’s test was performed to assess publication bias.
Results: Ninety-five trials enrolling 85,394 patients followed up for 30 weeks (median, IQR 24-54 weeks) were included in the analysis. Compared to control, treatment with DPP-4 inhibitors did not affect all-cause and CV mortality, as well as the risk of stroke in the short and long term Additionally, treatment with DPP4-inhibitors reduced the risk of MI in the short but not in the long term. DPP-4 inhibitors significantly increased the risk of new HF onset by 15.2% compared to control in the long but not in the short term. No heterogeneity among studies or publication bias was detected (Table)
Conclusions: DPP4 inhibitors do not affect all cause-, CV-mortality and stroke whereas the reduction in MI that is observed with short-term treatment does not persist long term. Long term use of DPP-4 inhibitors in diabetic patients is associated with increased risk of HF.
Author Disclosures: G. Savarese: None. P. Perrone-Filardi: None. C. D’Amore: None. C. Vitale: None. G.G. Camici: None. B. Trimarco: None. L. Pani: None. G. Rosano: None.
- © 2014 by American Heart Association, Inc.