Savarese Gianluigi, Perrone-Filardi Pasquale, D'Amore Carmen, Vitale Cristiana, Trimarco Bruno, Pani Luca, Rosano Giuseppe M C
Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy; IRCCS San Raffaele Roma, Italy.
Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy.
Int J Cardiol. 2015 Feb 15;181:239-44. doi: 10.1016/j.ijcard.2014.12.017. Epub 2014 Dec 3.
Dipeptidyl peptidase-4 inhibitors (DPP-4is) improve glucose control in patients with type 2 diabetes mellitus (DM); however, only few studies were properly designed to evaluate their cardiovascular (CV) effects. The purpose of this study was to assess the impact of DPP-4i treatment on CV morbidity and mortality.
Randomized clinical trials enrolling more than 200 patients, comparing DPP-4 versus placebo or active treatments in patients with DM and reporting at least one event among all-cause and CV mortality, myocardial infarction (MI), stroke and new onset of heart failure (HF) were included in the analysis.
Ninety-four trials enrolling 85,224 patients (median follow-up=29weeks) were included in the analysis. Compared to control, treatment with DPP-4i did not affect all-cause and CV mortality, as well as stroke, in the short and long terms (< and >=29weeks, respectively). DPP-4i reduced the risk of MI in the short (RR: 0.584 [95% CI: 0.361 to 0.943]; p=0.028), but not in the long term. Additionally, long-term treatment with DPP-4 was associated with a 15.8% increased risk of HF (RR: 1.158 [CI: 1.011 to 1.326]; p=0.034). No heterogeneity among studies or publication bias was detected.
DPP4is do not affect all cause- and CV-mortality and stroke in diabetic patients; the reduction in MI observed with short-term treatment does not persist in the long term. Long-term use of DPP-4i in diabetic patients is associated with increased risk of HF.
二肽基肽酶 -4抑制剂（DPP - 4i）可改善2型糖尿病（DM）患者的血糖控制；然而，仅有少数研究设计合理以评估其心血管（CV）效应。本研究的目的是评估DPP - 4i治疗对心血管发病率和死亡率的影响。
纳入随机临床试验，试验纳入超过200例患者，比较DPP - 4与安慰剂或活性治疗在糖尿病患者中的效果，并报告全因死亡率、心血管死亡率、心肌梗死（MI）、中风和新发心力衰竭（HF）中至少一项事件。
分析纳入了94项试验，共85224例患者（中位随访时间 = 29周）。与对照组相比，短期和长期（分别为<29周和≥29周）使用DPP - 4i治疗均不影响全因死亡率、心血管死亡率以及中风。DPP - 4i在短期内降低了心肌梗死风险（RR：0.584 [95% CI：0.361至0.943]；p = 0.028），但长期未降低。此外，长期使用DPP - 4与心力衰竭风险增加15.8%相关（RR：1.158 [CI：1.011至1.326]；p = 0.034）。未检测到研究间的异质性或发表偏倚。
DPP - 4i不影响糖尿病患者的全因死亡率、心血管死亡率和中风；短期治疗观察到的心肌梗死风险降低在长期并不持续。糖尿病患者长期使用DPP - 4i与心力衰竭风险增加相关。
