Meta-analysis of effect of dipeptidyl peptidase-4 inhibitors on cardiovascular risk in type 2 diabetes mellitus

Patil HR, Al Badarin FJ, Al Shami HA, et al. Meta-analysis of effect of dipeptidyl peptidase-4 inhibitors on cardiovascular risk in type 2 diabetes mellitus. Am J Cardiol. 2012;110:826-833.

Background
This meta-analysis from Patil and colleagues provides insights into the effects of DPP-4 inhibitors on cardiovascular (CV) events, and is the first adequately powered study that shows a class-wide effect for DPP-4 inhibitors in decreasing CV event risk over long-term treatment (≥24 weeks).

Design
Studies included in the meta-analysis (18 trials; N=8,544) were randomized, controlled trials comparing treatment with DPP-4 inhibitors (n=4,998) to another oral antihyperglycemic agent (n=3,546) for ≥24 weeks (median treatment duration: 46.4 weeks). Studies also included data regarding adverse CV outcomes associated with use of DPP-4 therapy. Development of adverse CV events* was the primary endpoint. (Click here for slide.) 

Results for the Primary Endpoint
When compared with placebo or other oral antihyperglycemic agents, use of DPP-4 inhibitors conferred:

  • Lower risk of adverse CV events: relative risk (RR), 0.48 (95% confidence interval [CI], 0.31-0.75; P=0.001)
  • Lower risk of nonfatal myocardial infarction or acute coronary syndrome: RR, 0.40 (95% CI, 0.18-0.88; P=0.02)

Longer studies included in the analysis (≥52 weeks’ duration) also showed decreased risk of the primary endpoint vs control treatment. (Click here for slide.) 

Safety
DPP-4 inhibitor therapy demonstrated a similar risk of adverse events when compared with placebo, but showed a significantly lower risk when compared with metformin, sulfonylureas, and thiazolidinediones.

*Defined as death from CV causes, nonfatal myocardial infarction or acute coronary syndrome, stroke and arrhythmias, and heart failure.

 

December 2012  

This overview was created by KnowledgePoint360 Group, LLC, and was not associated with funding via an educational grant or a promotional/commercial interest.  

Related content: 

Clinical Insights® in Diabetes :: November 2012  

Overview and slides: Meta-analysis: DPP-4 Inhibitors for Type 2 Diabetes  

 

Last Modified: 11/18/2013