Cardiovascular Effects of Dipeptidyl Peptidase-4 Inhibitors and Glucagon-Like Peptide-1 Receptor Agonists: a Review for
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NEW THERAPIES FOR CARDIOVASCULAR DISEASE (AA BAVRY, SECTION EDITOR)
Cardiovascular Effects of Dipeptidyl Peptidase-4 Inhibitors and Glucagon-Like Peptide-1 Receptor Agonists: a Review for the General Cardiologist Kershaw V. Patel 1 & Ashish Sarraju 2 & Ian J. Neeland 1 & Darren K. McGuire 1
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review Results from cardiovascular (CV) outcome trials have revealed important insights into the CV safety and efficacy of glucose-lowering agents, including dipeptidyl peptidase-4 inhibitors (DPP-4i) and glucagon-like peptide-1 receptor agonists (GLP-1RA). Recent Findings Among patients with T2DM, DPP-4i have no significant effect on risk of major adverse CV events (MACE: CV death, myocardial infarction, or stroke) with mixed results regarding risk for heart failure (HF). While sitagliptin and linagliptin have neutral effects on HF risk, saxagliptin significantly increases the risk of HF. The CV safety of the GLP-1RA class of medications has been clearly demonstrated, and select agents, such as liraglutide, semaglutide, albiglutide, and dulaglutide, reduce the risk of MACE in patients with T2DM and established CV disease. Summary CV outcome trials have demonstrated CV safety but not incremental efficacy for DPP-4i in most cases. Select GLP1RA have proven efficacy for MACE and should be considered by cardiologists for CV risk mitigation in the care of patients with T2DM and established CV disease. Keywords Atherosclerotic cardiovascular disease . Dipeptidyl peptidase-4 inhibitors . Glucagon-like peptide-1 receptor agonists . Heart failure . Type 2 diabetes mellitus
Introduction Cardiovascular disease (CVD) is a major cause of morbidity and mortality among patients with type 2 diabetes mellitus
This article is part of the Topical Collection on New Therapies for Cardiovascular Disease * Darren K. McGuire [email protected] Kershaw V. Patel [email protected] Ashish Sarraju [email protected] Ian J. Neeland [email protected] 1
Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-8830, USA
2
Division of Cardiovascular Medicine and Cardiovascular Institute, Stanford University, Stanford, CA, USA
(T2DM) [1, 2]. After years of progress in T2DM management, cardiovascular (CV) complication rates remain a major clinical concern, especially in young and middle-aged adults [2]. The risk of CVD is compounded by safety concerns of specific glucose-lowering medications. For example, rosiglitazone was associated with higher risk of CVD that eventually led to restrictions of its use [3]. While prescription rates of rosiglitazone declined, new classes of glucoselowering medications were emerging with important CV implications [4]. Dipeptidyl peptidase-4 inhibitors (DPP-4i) and glucagonlike peptide-1 receptor agonists (GLP-1RA) are incretin-based therapies approved for glycemic control since the mid-2000s [5]. Incretin hormon
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