The impact of vildagliptin on the daily glucose profile and coronary plaque stability in impaired glucose tolerance patients with coronary artery disease: VOGUE—A multicenter randomized controlled trial

BMC Cardiovascular Disorders

Takahiro Sawada¹  Tomofumi Takaya¹  Tsuyoshi Osue¹  Hiroya Kawai¹  Akihide Konishi²  Ken-ichi Hirata²  Toshiro Shinke²  Masaru Kuroda²  Hiroyuki Yamamoto²  Hiromasa Otake²  Takeshi Ohara³  Naoko Hashimoto³  Wataru Ogawa⁴  Yushi Hirota⁴  Kazuhiko Sakaguchi⁴  Takashi Omori⁵ 

[1] Division of Cardiovascular Medicine, Department of Internal Medicine, Hyogo Heart and Brain Center;Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine;Division of Diabetes and Endocrinology, Department of Internal Medicine, Hyogo Heart and Brain Center;Division of Diabetes and Endocrinology, Department of Internal Medicine, Kobe University Graduate School of Medicine;Kobe University Hospital Clinical & Translational Research Center;

关键词: Vildagliptin;    Fibrous cap thickness;    Mean amplitude of glycemic excursion;    Impaired glucose tolerance;   

DOI  :  10.1186/s12872-021-01902-0

来源: DOAJ

【 摘 要 】

Abstract Background The impact of reduction in glycemic excursion on coronary plaques remains unknown. This study aimed to elucidate whether a dipeptidyl peptidase 4 inhibitor could reduce the glycemic excursion and stabilize the coronary plaques compared with conventional management in coronary artery disease (CAD) patients with impaired glucose tolerance (IGT). Methods This was a multicenter, randomized controlled trial including CAD patients with IGT under lipid-lowering therapy receiving either vildagliptin (50 mg once a day) or no medication (control group) regarding glycemic treatment. The primary endpoint was changes in the minimum fibrous cap thickness and lipid arc in non-significant native coronary plaques detected by optical coherence tomography at 6 months after intervention. Glycemic variability expressed as the mean amplitude of glycemic excursion (MAGE) measured with a continuous glucose monitoring system was evaluated before and 6 months after intervention. Results A total of 20 participants with 47 lesions were allocated to either the vildagliptin group (10 participants, 22 lesions) or the control group (10 participants, 25 lesions). The adjusted difference of mean changes between the groups was − 18.8 mg/dl (95% confidence interval, − 30.8 to − 6.8) (p = 0.0064) for the MAGE (vildagliptin, − 20.1 ± 18.0 mg/dl vs. control, 2.6 ± 12.7 mg/dl), − 22.8° (− 40.6° to − 5.1°) (p = 0.0012) for the mean lipid arc (vildagliptin, − 9.0° ± 25.5° vs. control, 15.8° ± 16.8°), and 42.7 μm (15.3 to 70.1 μm) (p = 0.0022) for the minimum fibrous cap thickness (vildagliptin, 35.7 ± 50.8 μm vs. control, − 15.1 ± 25.2 μm). Conclusions Vildagliptin could reduce the MAGE at 6 months and may be associated with the decreased lipid arc and increased minimum FCT of the coronary plaques in CAD patients with IGT as compared with the control group. These findings may represent its potential stabilization effect on coronary plaques, which are characteristic in this patient subset. Trial registration Registered in the UMIN clinical trial registry (UMIN000008620), Name of the registry: VOGUE trial, Date of registration: Aug 6, 2012, URL: https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000010058

【 授权许可】

Unknown