title: Effects of dipeptidyl peptidase-4 inhibitors on cardiac and endothelial function in type 2 diabetes mellitus: A pilot study.
abstract: Recent studies have raised concerns regarding increased heart failure in patients on dipeptidyl peptidase-4 inhibitors. We examined whether dipeptidyl peptidase-4 inhibitors, compared to non-incretin-based therapies, have differential effects on left ventricular and endothelial function in patients with type 2 diabetes mellitus.
  
  
  
  A total of 25 type 2 diabetes mellitus patients commenced on a dipeptidyl peptidase-4 inhibitor were compared with 50 matched controls. Left ventricular systolic and diastolic function and flow-mediated dilatation were compared before and 12 months after treatment.
  
  
  
  At baseline, both dipeptidyl peptidase-4 inhibitor and control groups had elevated HbA1c and comparable subclinical left ventricular dysfunction (left ventricular global longitudinal strain: -15.4% vs -15.9%, p = 0.538; e' velocities: 6 vs 6 cm/s, p = 0.151, where e' is the peak mitral annular early diastolic tissue velocity). After 12 months, both groups had similar improvement in HbA1c. However, patients on dipeptidyl peptidase-4 inhibitors had greater improvement in systolic (ΔGLS: 3.6% vs 1.3%, p < 0.001), despite no significant differences in weight, blood pressure or lipid parameters in both groups. Diastolic (Δe': 38% vs 17%, p = 0.001) and endothelial function improved in the dipeptidyl peptidase-4 inhibitor group but not the control group (ΔFMD: 5% vs -1%, p = 0.029).
  
  
  
  We demonstrated significant improvements in LV systolic, diastolic and endothelial function in patients treated with a dipeptidyl peptidase-4 inhibitor over 12 months. These beneficial effects may provide some reassurance regarding the cardiovascular safety of dipeptidyl peptidase-4 inhibitors.
authors.affiliation: Department of Cardiology, Liverpool Hospital, Sydney, NSW, Australia University of New South Wales, Sydney, Australia melissa@unsw.edu.au.
authors.forename: Melissa
authors.initials: M
authors.lastname: Leung
authors.affiliation: Department of Cardiology, Liverpool Hospital, Sydney, NSW, Australia University of New South Wales, Sydney, Australia.
authors.forename: Dominic Y
authors.initials: DY
authors.lastname: Leung
authors.affiliation: University of New South Wales, Sydney, Australia Liverpool Diabetes Collaborative Research Unit, Ingham Institute, Liverpool, NSW, Australia.
authors.forename: Vincent W
authors.initials: VW
authors.lastname: Wong
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000187:drug effects / Q000378:metabolism; D001916:Brachial Artery / Q000000981:diagnostic imaging / Q000187:drug effects* / Q000503:physiopathology; D016022:Case-Control Studies; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis / Q000188:drug therapy* / Q000201:enzymology / Q000503:physiopathology; D018819:Dipeptidyl Peptidase 4 / Q000378:metabolism*; D054873:Dipeptidyl-Peptidase IV Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D015150:Echocardiography, Doppler; D004730:Endothelium, Vascular / Q000187:drug effects* / Q000503:physiopathology; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D006940:Hyperemia / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction / Q000187:drug effects*; D010865:Pilot Projects; D020127:Recovery of Function; D013997:Time Factors; D016896:Treatment Outcome; D014664:Vasodilation / Q000187:drug effects*; D016277:Ventricular Function, Left / Q000187:drug effects*
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D018819:Dipeptidyl Peptidase 4; D054873:Dipeptidyl-Peptidase IV Inhibitors; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human; C042807:DPP4 protein, human
keywords: Dipeptidyl peptidase-4 inhibition; cardiac function; diabetes mellitus; endothelial function