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Effect of Dipeptidyl Peptidase-4 Inhibitor on All-Cause Mortality and Coronary Revascularization in Diabetic Patients

전주영|손대원|김용진|조구영|이승표|황인창|김형관|성지동|박효은
한국심초음파학회 (Korean Society Of Echocardiography)|2015.12|Journal of Cardiovascular Imaging|제23권 제4호|pp. 233-243

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초록

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 inhibitorsin 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 diabetesmellitus who had diagnostic CT during 2007–2011 were included, and 1866 DPP-4 inhibitor users and 5179 non-users werecompared for outcome. The primary outcome was all-cause mortality and secondary outcome included any coronary revascularizationtherapy 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 mayhave beneficial effect in earlier stage of atherosclerosis.

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 inhibitorsin 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 diabetesmellitus who had diagnostic CT during 2007–2011 were included, and 1866 DPP-4 inhibitor users and 5179 non-users werecompared for outcome. The primary outcome was all-cause mortality and secondary outcome included any coronary revascularizationtherapy 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 mayhave beneficial effect in earlier stage of atherosclerosis.

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