Department of Cardiology, Chinese Hainan Hospital of PLA General Hospital, Sanya, Hainan Province, China.
Department of Radiation Oncology, Chinese PLA General Hospital, Beijing, China.
Atherosclerosis. 2020 May;300:10-18. doi: 10.1016/j.atherosclerosis.2020.03.015. Epub 2020 Mar 21.
Type 2 diabetes mellitus (T2DM) is a well-recognized independent risk factor for ASCVD, the aim of this study was to investigate the effects of a dipeptidyl peptidase-4 inhibitor, sitagliptin, on prevention of progression of coronary atherosclerosis assessed by three-dimensional quantitative coronary angiography (3D-QCA) in T2DM patients with coronary artery disease (CAD).
This was a prospective, randomized, double-center, open-label, blinded end point, controlled 18-month study in patients with CAD and T2DM. A total of 149 patients, who had at least 1 atherosclerotic plaque with 20%-80% luminal narrowing in a coronary artery, and had not undergone intervention during a clinically indicated coronary angiography or percutaneous coronary intervention, were randomized to sitagliptin group (n = 74) or control group (n = 75). Atherosclerosis progression was measured by repeat 3D-QCA examination in 88 patients at study completion. The primary outcome was changes in percent atheroma volume (PAV) from baseline to study completion measured by 3D-QCA. Secondary outcomes included change in 3D-QCA-derived total atheroma volume (TAV) and late lumen loss (LLL).
The primary outcome of PAV increased of 1.69% (95%CL, -0.8%-4.2%) with sitagliptin and 5.12% (95%CL, 3.49%-6.74%) with the conventional treatment (p = 0.023). The secondary outcome of change in TAV in patients treated with sitagliptin increased of 6.45 mm (95%CL,-2.46 to 6.36 mm) and 9.45 mm (95%CL,-4.52 to 10.14 mm) with conventional treatment (p = 0.023), however, no significant difference between groups was observed (p = 0.175). Patients treated with sitagliptin had similar LLL as compared with conventional antidiabetics (-0.06, 95%CL, -0.22 to 0.03 vs. -0.08, -0.23 to -0.03 mm, p = 0.689).
In patients with type 2 diabetes and coronary artery disease, treatment with sitagliptin resulted in a significantly lower rate of progression of coronary atherosclerosis compared with conventional treatment.
2 型糖尿病（T2DM）是 ASCVD 的公认独立危险因素，本研究旨在通过三维定量冠状动脉造影（3D-QCA）评估二肽基肽酶-4 抑制剂西他列汀对冠状动脉疾病（CAD）合并 T2DM 患者冠状动脉粥样硬化进展的影响。
这是一项前瞻性、随机、双中心、开放标签、盲终点、对照的 18 个月研究，纳入至少存在 1 处狭窄程度为 20%-80%的动脉粥样硬化斑块的 CAD 和 T2DM 患者。在临床上建议进行冠状动脉造影或经皮冠状动脉介入治疗期间，未进行干预的患者，被随机分配至西他列汀组（n=74）或对照组（n=75）。在研究结束时，88 例患者通过重复 3D-QCA 检查测量动脉粥样硬化进展情况。主要终点是通过 3D-QCA 测量的从基线到研究结束时的斑块体积百分比（PAV）变化。次要终点包括 3D-QCA 衍生的总斑块体积（TAV）和晚期管腔丢失（LLL）的变化。
西他列汀组的 PAV 增加了 1.69%（95%CL，-0.8%-4.2%），常规治疗组增加了 5.12%（95%CL，3.49%-6.74%）（p=0.023）。接受西他列汀治疗的患者 TAV 变化的次要终点增加了 6.45mm（95%CL，-2.46 至 6.36mm）和 9.45mm（95%CL，-4.52 至 10.14mm），而常规治疗组增加了 9.45mm（95%CL，-4.52 至 10.14mm）（p=0.023），但两组之间无显著差异（p=0.175）。与常规抗糖尿病药物相比，西他列汀治疗的患者 LLL 相似（-0.06，95%CL，-0.22 至 0.03 与-0.08，-0.23 至 -0.03mm，p=0.689）。
在 2 型糖尿病合并冠状动脉疾病的患者中，与常规治疗相比，西他列汀治疗可显著降低冠状动脉粥样硬化的进展速度。
