Effect of sitagliptin on the echocardiographic parameters of left ventricular diastolic function in patients with type 2 diabetes: a subgroup analysis of the PROLOGUE study

Cardiovascular Diabetology

for the PROLOGUE Study Investigators¹  Mamoru Nanasato²  Hisako Yoshida³  Masaaki Ito⁴  Yasuko K. Bando⁵  Toyoaki Murohara⁵  Hiroyuki Tsutsui⁶  Hiroyuki Daida⁷  Atsushi Tanaka⁸  Koichi Node⁸  Kenya Kusunose⁹  Hirotsugu Yamada⁹  Rie Amano⁹  Masataka Sata⁹  Munehide Matsuhisa^1,10  Masato Odawara^1,11  Haruo Kamiya^1,12 

[1] ;Cardiovascular Center, Japanese Red Cross Nagoya Daini Hospital;Clinical Research Center, Saga University;Department of Cardiology and Nephrology, Mie University Graduate School of Medicine;Department of Cardiology, Nagoya University Graduate School of Medicine;Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University;Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine;Department of Cardiovascular Medicine, Saga University;Department of Cardiovascular Medicine, Tokushima University Hospital;Department of Diabetes Therapeutics and Research Center, Tokushima University;Department of Diabetes, Endocrinology, Metabolism and Rheumatology, Tokyo Medical University;Division of Cardiology, Japanese Red Cross Nagoya Daiichi Hospital;

关键词: Sitagliptin;    T2DM;    Echocardiography;    Diastolic function;    NT-proBNP;   

DOI  :  10.1186/s12933-017-0546-2

来源: DOAJ

【 摘 要 】

Abstract Background Diabetes is associated closely with an increased risk of cardiovascular events, including diastolic dysfunction and heart failure that leads to a shortening of life expectancy. It is therefore extremely valuable to evaluate the impact of antidiabetic agents on cardiac function. However, the influence of dipeptidyl peptidase 4 inhibitors on cardiac function is controversial and a major matter of clinical concern. We therefore evaluated the effect of sitagliptin on echocardiographic parameters of diastolic function in patients with type 2 diabetes as a sub-analysis of the PROLOGUE study. Methods Patients in the PROLOGUE study were assigned randomly to either add-on sitagliptin treatment or conventional antidiabetic treatment. Of the 463 patients in the overall study, 115 patients (55 in the sitagliptin group and 60 in the conventional group) who had complete echocardiographic data of the ratio of peak early diastolic transmitral flow velocity (E) to peak early diastolic mitral annular velocity (e′) at baseline and after 12 and 24 months were included in this study. The primary endpoint of this post hoc sub-analysis was a comparison of the changes in the ratio of E to e′ (E/e′) between the two groups from baseline to 24 months. Results The baseline-adjusted change in E/e′ during 24 months was significantly lower in the sitagliptin group than in the conventional group (−0.18 ± 0.55 vs. 1.91 ± 0.53, p = 0.008), irrespective of a higher E/e′ value at baseline in the sitagliptin group. In analysis of covariance, sitagliptin treatment was significantly associated with change in E/e′ over 24 months (β = −9.959, p = 0.001), independent of other clinical variables at baseline such as blood pressure, HbA1c, and medications for diabetes. Changes in other clinical variables including blood pressure and glycemic parameters, and echocardiographic parameters, such as cardiac structure and systolic function, were comparable between the two groups. There was also no significant difference in the serum levels of N-terminal-pro brain natriuretic peptide and high-sensitive C-reactive protein between the two groups during the study period. Conclusions Adding sitagliptin to conventional antidiabetic regimens in patients with T2DM for 24 months attenuated the annual exacerbation in the echocardiographic parameter of diastolic dysfunction (E/e′) independent of other clinical variables such as blood pressure and glycemic control. Trial registration UMIN000004490 (University Hospital Medical Information Network Clinical Trials). https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000005356 ; registered November 1, 2010

【 授权许可】

Unknown