Abstract
Aim: WHO projects that diabetes will be the seventh leading cause of death in 2030. One of the macrovascular of diabetes is cardiovascular (CV) diseases, reported incidence of heart failure in diabetic patients is twice greater than control subjects and intensive use of antidiabetic drugs in diabetic patients increase CV mortality. This review will discusses the effect of DPP4 inhibitors (DPP-4i) on CV outcomes. Data sources: PubMed 32 journals, Google Scholar 17 journals, BioMed Central 5 journals and others 1 journal Method: A systemic search of all English-language articles up to 2020 was conducted using the following terms: dipeptidyl peptidase-4 inhibitors, sitagliptin, vildagliptin, saxagliptin, linagliptin, alogliptin, gemigliptin, anagliptin, teneligliptin, alogliptin, trelagliptin, omarigliptin, cardiovascular, and mechanism on cardiovascular diseases. Results: Positive effect on CV of DPP-4i mediated by activate PI3K, CAMP, eNOS and PKA, and negative effect because their effects in modulate SP, peptide YY, and neuropeptide Y. CV outcomes of DPP-4i versus placebo are variated for MACEs, which are reported on sitagliptin HR 0.98, 95% CI 0.89 to 1.08; Vildagliptin RR 0.82, 95% CI 0.61 to 1.11; Saxagliptin HR 1.00, 95% CI, 0.89 to 1.12; Linagliptin HR 0.78, 95% CI, 0.55 to 1.12; Alogliptin HR 0.85, CI 95%, 0.66 to 1.10; and Omarigliptin HR=0.85, CI 95%, 0.66-1.10. Conclusion: Based on the mechanism DPP-4i inhibitors have either cardioprotective actions or poorer outcomes on CV because their activities are connected with the inhibition of various substrates. DPP-4i sitagliptin, vildagliptin, saxagliptin, linagliptin, alogliptin, and omarigliptin did not significantly increase of MACE (major adverse cardiac events).
Highlights
Diabetes mellitus is a serious public health problem which the cases are significantly increase over the years
The primary composite cardiovascular outcome was 11.4% (n=839) of sitagliptin group and 11.6% (n=851) of placebo group (Hazard Ratio (HR), 0.98; 95% confidence interval (CI), 0.89 to 1.08), and identical in both the sitagliptin and placebo groups in the per-protocol analysis (9.6% (n=695) ; HR, 0.98; 95% CI, 0.88 to 1.09; p
SAVORTIMI 53 trial reported with primary end point event occurred in 613 patients in the saxagliptin group and in 609 patients in the placebo group, HR 1.00; 95% CI, 0.89 to 1.12; p=0.99
Summary
Diabetes mellitus is a serious public health problem which the cases are significantly increase over the years. The morbidity and mortality of diabetes mellitus are related with its cardiovascular complications such as atherosclerosis, myocardial infarction, stroke, and increased rate of heart failure. Almost half of patients with type 2 diabetes in risk to have heart failure, and those with both diabetes and history of heart failure have more severe prognosis [1]. It is well-established that heart failure is a major comorbid of diabetes mellitus. Make FDA suggests the manufacturers to assess cardiovascular safety for all novel class of oral antidiabetic agents including DPP4 inhibitor, especially in regards to heart failure. This review aims to assess the cardiovascular safety of DPP4 inhibitor
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