Impact of glycemic control with sitagliptin on the 2-year progression of arterial stiffness: a sub-analysis of the PROLOGUE study

Abstract

BackgroundNo conclusive evidence has been obtained yet on the significance of the effects of dipeptidyl peptidase-4 (DPP-4 inhibitor) treatment on the arterial stiffness in clinical settings. In addition, the effects of good glycemic control on the arterial stiffness have also not been clarified yet. As a sub-analysis of the PROLOGUE study, we examined the effect of a DPP-4 inhibitor (sitagliptin) on the 2-year progression of the arterial stiffness and also to determine the effect of good glycemic control on the rate of progression of the arterial stiffness.MethodsIn the PROLOGUE study, the study participants were either allocated to add-on sitagliptin treatment or to continued treatment with conventional anti-diabetic agents. Among the 463 participants of the PROLOGUE study, we succeeded in measuring the brachial-ankle pulse wave velocity (baPWV) at least two times during the 2-year study period in 96 subjects.ResultsThe changes in the baPWV during the study period were similar between the both groups (i.e., with/without staglipitin), overall. On the other hand, when the study subjects were divided into two groups according to the glycemic control status during the study period {good glycemic control group (GC) = hemoglobin (Hb)A1c <7.0 at both 12 and 24 months after the treatment randomization; poor glycemic control group (PC) = HbA1c ≥7.0 at either 12 months, 24 months, or both}, the 2-year increase of the baPWV was marginally significantly larger in the PC group (144 ± 235 cm/s) as compared to that the GC group (−10 ± 282 cm/s) (p = 0.036).ConclusionWhile the present study could not confirm the beneficial effect of sitagliptin per se on the arterial stiffness, the results suggested that good glycemic control appears to be beneficial for delaying the annual progression of the arterial stiffness. Trial registration University Hospital Medical Information Network Clinical Trials Registry UMIN000004490

Improvement in Brachial Endothelial Vasomotor Function and Brachial-Ankle Pulse Wave Velocity Reduces the Residual Risk for Cardiovascular Events after Optimal Medical Treatment in Patients with Coronary Artery Disease

“…Measuring baPWV, a parameter closely correlated with aortic PWV and carotid-femoral PWV, which are well-established vascular tests for the evaluation of atherosclerosis and cardiovascular risks 10,11) , is easy to perform. In previous studies, cardiovascular risk reduction has been shown to be related to the improvement of baPWV after modification of atherosclerotic risk burden, including BP lowering, LDL lowering, and glucose lowering [19][20][21] . FMD, a marker of endothelium-dependent dilation of the brachial artery, reflects systemic endothelial function, as well as atherosclerotic risk burden at the time of FMD measurement.…”

Effects of 6-month treatment with the glucagon like peptide-1 analogue liraglutide on arterial stiffness, left ventricular myocardial deformation and oxidative stress in subjects with newly diagnosed type 2 diabetes

“…Sitagliptin has also failed to confirm a beneficial net effect on pulse wave velocity within 2 years of therapy. However, the results suggested that achievement of good glycaemic control inhibits the annual progression of the arterial stiffness [ 35 ].…”

Dipeptidyl peptidase-4 inhibitor decreases the risk of atrial fibrillation in patients with type 2 diabetes: a nationwide cohort study in Taiwan

“…It is unclear if GLP-1 receptor agonists was associated with AF [ 37 ]. At the present time, it is still unclear whether DPP4i would lead to better outcomes with a reduction in incidence of major adverse cardiovascular events [ 38 – 41 ]. Recent large scale clinical trials, including EXAMINE, SAVOR-TIMI53, and TECOS, all failed to show significant improvement in cardiovascular outcomes in type 2 diabetic patients treated with DPP4i [ 38 , 42 , 43 ].…”