Incretin-based agents in type 2 diabetic patients at cardiovascular risk: compare the effect of GLP-1 agonists and DPP-4 inhibitors on cardiovascular and pancreatic outcomes

Cardiovascular Diabetology

Original Investigation

Yan Yang¹  Wentao He¹  Mengni Li¹  Yongping Xu¹  Jianhua Zhang¹  Shiying Shao¹  Junhui Xie¹  Jing Jia¹  Zeqing Zhang¹  Shujun Zhang¹  Xuefeng Yu¹  Puhan Lu¹  Xi Chen¹ 

[1] Division of Endocrinology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, 430030, Wuhan, Hubei Province, People’s Republic of China;

关键词: Glucagon-like peptide-1 agonists;    Dipeptidyl peptidase-4 inhibitors;    Type 2 diabetes mellitus;    Cardiovascular outcomes;    Acute pancreatitis;   

DOI  :  10.1186/s12933-017-0512-z

 received in 2016-11-15, accepted in 2017-02-21,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundIncretin-based agents, including dipeptidyl peptidase-4 inhibitors (DPP-4Is) and glucagon-like peptide-1 agonists (GLP-1As), work via GLP-1 receptor for hyperglycemic control directly or indirectly, but have different effect on cardiovascular (CV) outcomes. The present study is to evaluate and compare effects of incretin-based agents on CV and pancreatic outcomes in patients with type 2 diabetes mellitus (T2DM) and high CV risk.MethodsSix prospective randomized controlled trials (EXMAINE, SAVOR-TIMI53, TECOS, ELIXA, LEADER and SUSTAIN-6), which included three trials for DPP-4Is and three trials for GLP-1As, with 55,248 participants were selected to assess the effect of different categories of incretin-based agents on death, CV outcomes (CV mortality, major adverse CV events, nonfatal myocardial infarction, nonfatal stroke, heart failure hospitalization), pancreatic events (acute pancreatitis and pancreatic cancer) as well as on hypoglycemia.ResultsWhen we evaluated the combined effect of six trials, the results suggested that incretin-based treatment had no significant effect on overall risks of CV and pancreatic outcomes compared with placebo. However, GLP-1As reduced all-cause death (RR = 0.90, 95% CI 0.82–0.98) and CV mortality (RR = 0.84, 95% CI 0.73–0.97), whereas DPP-4Is had no significant effect on CV outcomes but elevated the risk for acute pancreatitis (OR = 1.76, 95% CI 1.14–2.72) and hypoglycemia (both any and severe hypoglycemia), while GLP-1As lowered the risk of severe hypoglycemia.ConclusionsGLP-1As decreased risks of all-cause and CV mortality and severe hypoglycemia, whereas DPP-4Is had no effect on CV outcomes but increased risks in acute pancreatitis and hypoglycemia.

【 授权许可】

CC BY   
© The Author(s) 2017