Meta-Analysis
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. Oct 26, 2021; 13(10): 585-592
Published online Oct 26, 2021. doi: 10.4330/wjc.v13.i10.585
Cardiovascular efficacy and safety of dipeptidyl peptidase-4 inhibitors: A meta-analysis of cardiovascular outcome trials
Dimitrios Ioannis Patoulias, Aristi Boulmpou, Eleftherios Teperikidis, Alexandra Katsimardou, Fotios Siskos, Michael Doumas, Christodoulos E Papadopoulos, Vassilios Vassilikos
Dimitrios Ioannis Patoulias, Alexandra Katsimardou, Fotios Siskos, Michael Doumas, Second Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, Hippokration General Hospital, Thessaloniki 54642, Greece
Aristi Boulmpou, Eleftherios Teperikidis, Christodoulos E Papadopoulos, Vassilios Vassilikos, Third Department of Cardiology, Aristotle University of Thessaloniki, Hippokration General Hospital, Thessaloniki 54642, Greece
Author contributions: Patoulias DI and Doumas M conceived and designed the study; Patoulias DI, Boulmpou A and Teperikidis E collected and analyzed data; Patoulias DI, Boulmpou A and Siskos F performed study quality and risk of bias assessment; Patoulias DI, Boulnpou A, Katsimardou A and Papadopoulos CE wrote the first draft of the study; Doumas M and Vassilikos V critically revised the final draft.
Conflict-of-interest statement: The authors declare no conflict of interest.
PRISMA 2009 Checklist statement: The present meta-analysis was conducted according to 2009 PRISMA Guidelines.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Dimitrios Ioannis Patoulias, MD, MSc, Doctor, Research Fellow, Research Scientist, Second Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, Hippokration General Hospital, Konstantinoupoleos 49 Str., Thessaloniki 54642, Greece. dipatoulias@gmail.com
Received: March 29, 2021
Peer-review started: March 29, 2021
First decision: June 25, 2021
Revised: July 8, 2021
Accepted: September 10, 2021
Article in press: September 10, 2021
Published online: October 26, 2021
Processing time: 205 Days and 14.3 Hours
ARTICLE HIGHLIGHTS
Research background

Dipeptidyl peptidase-4 (DPP-4) inhibitors are a safe and efficacious treatment option in type 2 diabetes mellitus (T2DM).

Research motivation

Recently, several large, cardiovascular-outcome, randomized controlled trials (RCTs) with DPP-4 inhibitors in patients with T2DM have been published, raising some doubts on the cardiovascular efficacy and safety of this drug class.

Research objectives

Herein the authors provide the most updated and broad relevant meta-analysis by pooling data of interest from the available cardiovascular-outcome RCTs, addressing the cardiovascular efficacy and safety of this drug class.

Research methods

The authors searched PubMed and grey literature sources for all published RCTs assessing cardiovascular outcomes with DPP-4 inhibitors compared to placebo until October 2020.

Research results

Overall, DPP-4 inhibitors seem to have a neutral effect on most surrogate cardiovascular outcome endpoints, such as cardiovascular death, myocardial infarction, stroke, hospitalization for heart failure decompensation, hospitalization for unstable angina or coronary revascularization.

Research conclusions

DPP-4 inhibitors do not provide any clear cardiovascular benefit in patients with T2DM.

Notably, DPP-4 inhibitors are not associated with a significant effect on the risk for major cardiac arrhythmias, except for atrial flutter, increasing the risk by 52% compared to placebo.

Research perspectives

DPP-4 inhibitors do not provide any clear cardiovascular benefit in patients with T2DM.