Abstract 11806: Not Glycemic Control Using Sitagliptin But Lipid Control is Associated With Change in Coronary Atherosclerosis in Patients With Type 2 Diabetes -A Serial Integrated Backscatter Intravascular Ultrasound Study
Introduction: Dipeptidyl peptidase-4 (DPP-4) inhibitors have anti-atherogenic effects in an animal model. However, clinical usefulness of DPP-4 inhibitors, particularly effects of these drugs on coronary atherosclerosis has not been fully evaluated.
Hypothesis: We assessed the hypothesis that sitagliptin, a DPP-4 inhibitor, has beneficial effects on coronary atherosclerosis beyond its hypoglycemic action.
Methods: A prospective, open-labeled, randomized multicenter study was performed at 6 Japanese centers. Twenty-eight patients with type 2 diabetes who have undergone elective percutaneous coronary intervention (PCI) were randomly assigned to either the sitagliptin group (group S) or control group (group C). Neither DPP-4 inhibitors nor glucagon-like peptide-1 analogues have been used in group C during study period. Non- PCI lesions were evaluated by integrated backscatter (IB)-intravascular ultrasound (IVUS) at the time of PCI and at 48-week follow-up. The primary end point was percentage change in plaque volume measured using grayscale IVUS and the secondary end point was changes in plaque compositions measured using IB-IVUS.
Results: Grayscale IVUS analysis demonstrated that plaque volume tended to be decreased in both groups (group S: -1.7%; group C: -3.2%), but could not reach statistically significance. In addition, percentage changes in plaque volume did not differ between the 2 groups. On IB-IVUS analysis, a significant decrease in the lipid component (group S: from 200.1 to 179.8 mm3, p=0.02; group C: from 298.3 to 256.6 mm3, p=0.1) and an increase in the calcified component (group S: from 2.1 to 3.2 mm3, p=0.06; group C: from 2.3 to 4.8 mm3, p=0.04) were observed. Univariate and multivariate regression analyses showed that sitagliptin use did not correlate with a decrease in the lipid component, whereas percentage change in serum non high-density lipoprotein cholesterol (HDL-C) was an independent and significant predictor associated with change in the lipid component (β=0.454, p=0.04).
Conclusions: Sitagliptin had no effects on coronary atherosclerosis in patients with type 2 diabetes. Not glycemic control but lipid control, particularly a decrease in non-HDL-C was associated with the reduction in lipid component.
Author Disclosures: T. Nozue: None. K. Fukui: None. Y. Koyama: None. H. Fujii: None. T. Kunishima: None. H. Hikita: None. K. Hibi: None. A. Miyazawa: None. I. Michishita: None.
- © 2015 by American Heart Association, Inc.