Abstract
The effects of antidiabetic agents on lipoprotein subclasses are assumed to be pivotal, but this assumption has not been studied. We evaluated lipoprotein subclasses in patients, randomly selected from REASON (Randomized Evaluation of Anagliptin versus Sitagliptin On low-density lipoproteiN cholesterol in diabetes) Trial participants, with type-2 diabetes treated with either anagliptin or sitagliptin. We measured total cholesterol (TC) and triglycerides (TG) in 4 (chylomicron (CM), very low-density lipoprotein (VLDL), low density lipoprotein (LDL), and high-density lipoprotein (HDL)) lipoprotein classes and 20 (2 CM, 5 VLDL, 6 LDL, and 7 HDL) lipoprotein subclasses. Between 0 and 52 weeks, TC and TG in lipoprotein and the lipoprotein subclass were distributed differently in patients treated with anagliptin and sitagliptin. The preferable changes in TC and TG levels were observed dominantly in the anagliptin-treated group under standard statin therapy, but the benefits were observed in both the anagliptin- and sitagliptin-treated groups, at least partially under strong statin therapy. In future studies, the atherogenic properties of lipoprotein subclasses might be considered when employing antidiabetic dipeptidyl peptidase-4 (DPP-4) inhibitors, especially in patients with type-2 diabetes who are at risk of atherosclerotic cardiovascular disease (ASCVD) or are undergoing statin treatment.
Highlights
To prevent atherosclerotic cardiovascular disease (ASCVD) in type-2 diabetes mellitus (T2DM), controlling low-density lipoprotein cholesterol (LDL-C) levels is crucial [1,2]
A Randomized Evaluation of Anagliptin versus Sitagliptin on low-density lipoproteiN cholesterol in diabetes (REASON) Trial was a multicenter, randomized, open-label, parallel-group trial to determine the effectiveness of anagliptin versus sitagliptin on reduction in LDL-C in patients with type-2 diabetes with either prior coronary artery disease (CAD)
(0.7) and LDL-C of 113 (24) mg/dL were comparable with the REASON Trial participants (n = 353)
Summary
To prevent atherosclerotic cardiovascular disease (ASCVD) in type-2 diabetes mellitus (T2DM), controlling low-density lipoprotein cholesterol (LDL-C) levels is crucial [1,2]. HMG-CoA reductase inhibitors (statins) are widely used to target recommended levels of LDL-C in T2DM [3,4]. It has been suggested that anagliptin has a unique action among DPP-4 inhibitors due to its ability to lower LDL-C [8]. A Randomized Evaluation of Anagliptin versus Sitagliptin on low-density lipoproteiN cholesterol in diabetes (REASON) Trial was a multicenter, randomized, open-label, parallel-group trial to determine the effectiveness of anagliptin versus sitagliptin on reduction in LDL-C in patients with type-2 diabetes with either prior coronary artery disease (CAD)
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