Preventive cardiologyMeta-Analysis of Effect of Dipeptidyl Peptidase-4 Inhibitors on Cardiovascular Risk in Type 2 Diabetes Mellitus
Section snippets
Methods
This meta-analysis was designed to evaluate the CV safety of DPP4 inhibitors in patients with type 2 DM. We adhered to the recommendations set forth by the Quality of Reporting of Meta-analyses statement for improving the quality of meta-analyses.2
A computerized literature search was performed to identify RCTs comparing DPP4 inhibitors to other oral hypoglycemic agents for treatment of type 2 DM. MEDLINE (from 1980 to September 2011), Cochrane Collaborative database, Scopus (//www.scopus.com
Results
Of the 1,304 citations identified initially, 28 full-text articles were reviewed for relevance. Ten RCTs that examined the efficacy of DPP4 inhibitors but did not report data on adverse CV events, including 5,631 patients, were excluded. Eighteen nonoverlapping RCTs met our inclusion criteria (Figure 1). Pooled analysis included 8,544 patients (4,998 randomized to a DPP4 inhibitor and 3,546 to placebo or other oral hypoglycemic agents). Of patients randomized to receive DPP4 inhibitor therapy,
Discussion
The present meta-analysis is the first adequately powered study to demonstrate that DPP4 inhibitors as a class appear to decrease the risk of CV events during long-term treatment. In contrast, multiple drugs for type 2 DM including sulfonylureas, insulin, and rosiglitazone have been associated with increased risk of CV events.21, 22 Because of concerns regarding this potential for type 2 DM drugs to worsen CV prognosis, since 2008 the Federal Drug Administration has required that all new
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