title: Effect of hypoglycemic agents on ischemic preconditioning in patients with type 2 diabetes and symptomatic coronary artery disease.
abstract: OBJECTIVE
  To assess the effect of two hypoglycemic drugs on ischemic preconditioning (IPC) patients with type 2 diabetes and coronary artery disease (CAD).
  
  
  METHODS
  We performed a prospective study of 96 consecutive patients allocated into two groups: 42 to group repaglinide (R) and 54 to group vildagliptin (V). All patients underwent two consecutive exercise tests (ET1 and ET2) in phase 1 without drugs. In phase 2, 1 day after ET1 and -2, 2 mg repaglinide three times daily or 50 mg vildagliptin twice daily was given orally to patients in the respective group for 6 days. On the seventh day, 60 min after 6 mg repaglinide or 100 mg vildagliptin, all patients underwent two consecutive exercise tests (ET3 and ET4).
  
  
  RESULTS
  In phase 1, IPC was demonstrated by improvement in the time to 1.0 mm ST-segment depression and rate pressure product (RPP). All patients developed ischemia in ET3; however, 83.3% of patients in group R experienced ischemia earlier in ET4, without significant improvement in RPP, indicating the cessation of IPC (P < 0.0001). In group V, only 28% of patients demonstrated IPC cessation, with 72% still having the protective effect (P < 0.0069).
  
  
  CONCLUSIONS
  Repaglinide eliminated myocardial IPC, probably by its effect on the KATP channel. Vildagliptin did not damage this protective mechanism in a relevant way in patients with type 2 diabetes and CAD, suggesting a good alternative treatment in this population.
authors.affiliation: Department of Atherosclerosis, Heart Institute of the University of São Paulo, São Paulo, Brazil.
authors.forename: Rosa Maria
authors.initials: RM
authors.lastname: Rahmi
authors.forename: Augusto Hiroshi
authors.initials: AH
authors.lastname: Uchida
authors.forename: Paulo Cury
authors.initials: PC
authors.lastname: Rezende
authors.forename: Eduardo Gomes
authors.initials: EG
authors.lastname: Lima
authors.forename: Cibele Larrosa
authors.initials: CL
authors.lastname: Garzillo
authors.forename: Desiderio
authors.initials: D
authors.lastname: Favarato
authors.forename: Celia M C
authors.initials: CM
authors.lastname: Strunz
authors.forename: Myrthes
authors.initials: M
authors.lastname: Takiuti
authors.forename: Priscyla
authors.initials: P
authors.lastname: Girardi
authors.forename: Whady
authors.initials: W
authors.lastname: Hueb
authors.forename: Roberto
authors.initials: R
authors.lastname: Kalil Filho
authors.forename: José A F
authors.initials: JA
authors.lastname: Ramires
mesh_terms: D000218:Adamantane / Q000009:adverse effects / Q000031:analogs & derivatives / Q000627:therapeutic use; D000368:Aged; D002219:Carbamates / Q000009:adverse effects / Q000627:therapeutic use; D003324:Coronary Artery Disease / Q000188:drug therapy*; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D019194:Ischemic Preconditioning; D008297:Male; D008875:Middle Aged; D009570:Nitriles / Q000009:adverse effects / Q000627:therapeutic use; D010880:Piperidines / Q000009:adverse effects / Q000627:therapeutic use; D011446:Prospective Studies; D011759:Pyrrolidines / Q000009:adverse effects / Q000627:therapeutic use; D000077597:Vildagliptin
chemical_list: D002219:Carbamates; D007004:Hypoglycemic Agents; D009570:Nitriles; D010880:Piperidines; D011759:Pyrrolidines; C072379:repaglinide; D000077597:Vildagliptin; D000218:Adamantane