Journal of Cardiovascular Imaging

Korean Society of Echocardiography (한국심초음파학회)
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EFFECT OF DIPEPTIDYL PEPTIDASE-4 INHIBITOR ON ALL-CAUSE MORTALITY AND CORONARY REVASCULARIZATION IN DIABETIC PATIENTS

  • Park, Hyo Eun (Division of Cardiology, Healthcare System Gangnam Center, Seoul National University Hospital) ;
  • Jeon, Jooyeong (Master in Statistics, Department of Statistics, Sungkyunkwan University) ;
  • Hwang, In-Chang (Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital) ;
  • Sung, Jidong (Division of Cardiology, Department of Internal Medicine, Sungkyunkwan University College of Medicine, Samsung Medical Center) ;
  • Lee, Seung-Pyo (Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital) ;
  • Kim, Hyung-Kwan (Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital) ;
  • Cho, Goo-Yeong (Division of Cardiology, Department of Internal Medicine, Seoul National University Bundang Hospital) ;
  • Sohn, Dae-Won (Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital) ;
  • Kim, Yong-Jin (Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital)
  • Received : 2015.08.04
  • Accepted : 2015.11.18
  • Published : 2015.12.27
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Abstract

BACKGROUND: Anti-atherosclerotic effect of dipeptidyl peptidase-4 (DPP-4) inhibitors has been suggested from previous studies, and yet, its association with cardiovascular outcome has not been demonstrated. We aimed to evaluate the effect of DPP-4 inhibitors in reducing mortality and coronary revascularization, in association with baseline coronary computed tomography (CT). METHODS: The current study was performed as a multi-center, retrospective observational cohort study. All subjects with diabetes mellitus who had diagnostic CT during 2007-2011 were included, and 1866 DPP-4 inhibitor users and 5179 non-users were compared for outcome. The primary outcome was all-cause mortality and secondary outcome included any coronary revascularization therapy after 90 days of CT in addition to all-cause mortality. RESULTS: DPP-4 inhibitors users had significantly less adverse events [0.8% vs. 4.4% in users vs. non-users, adjusted hazard ratios (HR) 0.220, 95% confidence interval (CI) 0.102-0.474, p = 0.0001 for primary outcome, 4.1% vs. 7.6% in users vs. non-users, HR 0.517, 95% CI 0.363-0.735, p = 0.0002 for secondary outcome, adjusted variables were age, sex, presence of hypertension, high sensitivity C-reactive protein, glycated hemoglobin, statin use, coronary artery calcium score and degree of stenosis]. Interestingly, DPP-4 inhibitor seemed to be beneficial only in subjects without significant stenosis (adjusted HR 0.148, p = 0.0013 and adjusted HR 0.525, p = 0.0081 for primary and secondary outcome). CONCLUSION: DPP-4 inhibitor is associated with reduced all-cause mortality and coronary revascularization in diabetic patients. Such beneficial effect was significant only in those without significant coronary stenosis, which implies that DPP-4 inhibitor may have beneficial effect in earlier stage of atherosclerosis.

Keywords

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