title: Cardiovascular efficacy of sitagliptin in patients with diabetes at high risk of cardiovascular disease: a 12-month follow-up.
abstract: BACKGROUND
  Gliptins should have beneficial effects beyond glycemic control, potentially on the pathophysiology of cardiovascular (CV) diseases, with some basic studies demonstrating this possibility. However, we are yet to answer whether there are any direct CV effects in the clinical setting. We aimed to examine the beneficial effects of sitagliptin in Japanese patients with diabetes and high CV risk for 12 months.
  
  
  METHODS
  This was a prospective, multicenter, observational study of 205 patients with type 2 diabetes. All participants had more than one major CV risk factor and were treated with sitagliptin for 12 months. At 3 or 12 months, we examined the effects of treatment on glycemic control, CV function (by electrocardiography, echocardiography, and reactive hyperemia-peripheral arterial tonometry), and CV biomarkers.
  
  
  RESULTS
  Patients were predominantly elderly (68.8 ± 9.9 years) and male (71.5 %) and typically had more than three CV risk factors (79.2 %). Treatment with sitagliptin significantly reduced the hemoglobin A1c (HbA1c) level from 7.09 % ± 0.81 % at baseline to 6.67 % ± 0.69 % at 3 months and 6.68 % ± 0.73 % at 12 months (both P < 0.001). The reduction in HbA1c was also in tandem with the decrease in the level of high-sensitive C-reactive protein throughout the study. Independent of the change in HbA1c, sitagliptin reduced systolic (-7.0 ± 18.9 mmHg) and diastolic blood pressure (-5.1 ± 11.7 mmHg) at 12 months, and this was associated with a decrease in urinary albumin. In contrast, there were no beneficial effects on cardiac and endothelial function or on the levels of serum B-type natriuretic peptide, high-sensitive troponin T, and urinary 8-hydroxy-2'-deoxyguanosine.
  
  
  CONCLUSIONS
  In Japanese patients with diabetes and multiple CV risk factors, sitagliptin showed a decrease in blood pressure associated with an improvement in albuminuria in addition to glycemic control.
  
  
  BACKGROUND
  UMIN000005663.
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Kinki University, 377-2 Ohno-Higashi, Osakasayama, 589-8511, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Nakamura
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Kinki University, 377-2 Ohno-Higashi, Osakasayama, 589-8511, Japan.
authors.forename: Yoshitaka
authors.initials: Y
authors.lastname: Iwanaga
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Kinki University, 377-2 Ohno-Higashi, Osakasayama, 589-8511, Japan.
authors.forename: Yuki
authors.initials: Y
authors.lastname: Miyaji
authors.affiliation: Hirakata Kousai Hospital, Hirakata, Japan.
authors.forename: Ryuji
authors.initials: R
authors.lastname: Nohara
authors.affiliation: Ishimura Clinic, Osaka, Japan.
authors.forename: Takao
authors.initials: T
authors.lastname: Ishimura
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Kinki University, 377-2 Ohno-Higashi, Osakasayama, 589-8511, Japan. smiyazak@med.kindai.ac.jp.
authors.forename: Shunichi
authors.initials: S
authors.lastname: Miyazaki
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000419:Albuminuria / Q000150:complications / Q000188:drug therapy; D001786:Blood Glucose / Q000378:metabolism; D001794:Blood Pressure / Q000187:drug effects; D002318:Cardiovascular Diseases / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000175:diagnosis / Q000188:drug therapy*; D054873:Dipeptidyl-Peptidase IV Inhibitors / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D000068900:Sitagliptin Phosphate / Q000627:therapeutic use*
chemical_list: D001786:Blood Glucose; D054873:Dipeptidyl-Peptidase IV Inhibitors; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D000068900:Sitagliptin Phosphate
keywords: Blood pressure; Cardiovascular risk; Sitagliptin; Type 2 diabetes; Urine albumin