Effects of dipeptidyl peptidase-4 inhibitor sitagliptin on coronary atherosclerosis as assessed by intravascular ultrasound in type 2 diabetes mellitus with coronary artery disease

Abstract

BackgroundIt is unclear whether the addition of dipeptidyl peptidase-4 inhibitors (DPP4-I) to statins may cause coronary plaque regression in type 2 diabetes mellitus (T2DM) patients with coronary artery disease (CAD). Methods and resultsSeventy-five T2DM patients with CAD who underwent percutaneous coronary intervention under intravascular ultrasound (IVUS) guidance were randomized to receive DPP4-I sitagliptin (sitagliptin group) or not to receive DPP4-I (non-DPP4-I group) as an add-on treatment to statins, and were followed-up for 8–12months. Patients with analyzable IVUS examinations of the non-culprit segment were included in the primary analysis. Sitagliptin group (n=28) and non-DPP4-I group (n=24) had significant (p<0.05) and similar reduction in low-density lipoprotein cholesterol levels (−12±24 and −12±23mg/dL), and had no significant changes in hemoglobin A1c levels. Nominal change in percent atheroma volume (PAV), the primary endpoint, was not significant in both the sitagliptin and non-DPP4-I groups [mean (95% CI): +1.1% (−0.5 to 2.7%) and 0.2% (−1.5 to 1.9%)]. The difference in change in PAV between sitagliptin and non-DPP4-I groups was also not significant [0.89% (−1.46%–3.25%)]. ConclusionsThe addition of sitagliptin to statins did not cause coronary plaque regression in T2DM with CAD.