title: Cardiovascular and heart failure safety profile of vildagliptin: a meta-analysis of 17 000 patients.
abstract: OBJECTIVE
  To report the cardiovascular (CV) safety profile and heart failure (HF) risk of vildagliptin from a large pool of studies, including trials in high-risk patients with type 2 diabetes mellitus (T2DM), such as those with congestive HF and/or moderate/severe renal impairment.
  
  
  METHODS
  We conducted a retrospective meta-analysis of prospectively adjudicated CV events. Patient-level data were pooled from 40 double-blind, randomized controlled phase III and IV vildagliptin studies. The primary endpoint was occurrence of major adverse CV events (MACEs; myocardial infarction, stroke and CV death). Assessments of the individual MACE components and HF events (requiring hospitalization or new onset) were secondary endpoints. The risk ratio (RR) of vildagliptin (50 mg once- and twice-daily combined) versus comparators (placebo and all non-vildagliptin treatments) was calculated using the Mantel-Haenszel (M-H) method.
  
  
  RESULTS
  Of the 17 446 patients, 9599 received vildagliptin (9251.4 subject-years of exposure) and 7847 received comparators (7317.0 subject-years of exposure). The mean age of the patients was 57 years, body mass index 30.5 kg/m(2) (nearly 50% obese), glycated haemoglobin concentration 8.1% and T2DM duration 5.5 years. A MACE occurred in 83 (0.86%) vildagliptin-treated patients and 85 (1.20%) comparator-treated patients, with an M-H RR of 0.82 [95% confidence interval (CI) 0.61-1.11]. Similar RRs were observed for the individual events. Confirmed HF events were reported in 41 (0.43%) vildagliptin-treated patients and 32 (0.45%) comparator-treated patients, with an M-H RR 1.08 (95% CI 0.68-1.70).
  
  
  CONCLUSIONS
  This large meta-analysis indicates that vildagliptin is not associated with an increased risk of adjudicated MACEs relative to comparators. Moreover, this analysis did not find a significant increased risk of HF in vildagliptin-treated patients.
authors.affiliation: Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.
authors.forename: G
authors.initials: G
authors.lastname: McInnes
authors.affiliation: University Hospital Llandough, Cardiff, UK.
authors.forename: M
authors.initials: M
authors.lastname: Evans
authors.affiliation: Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Del Prato
authors.affiliation: Division of Endocrinology, University Hospital Leipzig, Leipzig, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Stumvoll
authors.affiliation: Novartis Pharma AG, Basel, Switzerland.
authors.forename: A
authors.initials: A
authors.lastname: Schweizer
authors.affiliation: Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA.
authors.forename: V
authors.initials: V
authors.lastname: Lukashevich
authors.affiliation: Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA.
authors.forename: Q
authors.initials: Q
authors.lastname: Shao
authors.affiliation: Novartis Pharma AG, Basel, Switzerland.
authors.forename: W
authors.initials: W
authors.lastname: Kothny
mesh_terms: D000218:Adamantane / Q000009:adverse effects / Q000031:analogs & derivatives*; D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000139:chemically induced*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy*; D054873:Dipeptidyl-Peptidase IV Inhibitors / Q000009:adverse effects*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006333:Heart Failure / Q000139:chemically induced*; D006801:Humans; D007004:Hypoglycemic Agents / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D009570:Nitriles / Q000009:adverse effects*; D011759:Pyrrolidines / Q000009:adverse effects*; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies; D000077597:Vildagliptin
chemical_list: D000218:Adamantane; D054873:Dipeptidyl-Peptidase IV Inhibitors; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D009570:Nitriles; D011759:Pyrrolidines; D000077597:Vildagliptin; C517652:hemoglobin A1c protein, human
keywords: antidiabetic drug; cardiovascular disease; dipeptidyl peptidase-4 inhibitor; meta-analysis