BACKGROUND Dipeptidyl peptidase 4 (DPP-4) inhibitors are newer oral anti-diabetic agents which have been approved by the Food and Drug Administration for the treatment of patients with type 2 diabetes mellitus (T2DM). In this analysis, we aimed to systematically compare the cardiovascular outcomes associated with DPP-4 inhibitors versus non-DPP-4 inhibitor users. METHODS All English publications that compared the use of DPP-4 inhibitors and that reported cardiovascular outcomes in patients with T2DM were searched using specific terms. Studies were included if they satisfied the following inclusion criteria: They were randomized trials or observation cohorts/registries comparing DPP-4 inhibitors use in patients with T2DM; The studies included a large sample size of participants; And they reported cardiovascular outcomes as their main endpoints. RevMan 5.3 was used to analyze the data, and odds ratios (OR) with 95% confidence intervals (CI) were used to represent the results. RESULTS A total number of 157,478 participants with T2DM were included. Seventy-six thousand and twenty six patients were assigned to the DPP-4 inhibitor group whereas 81,452 patients were assigned to the control group. Results of the current analysis showed that during a mean follow-up time period ranging from 52 to 152 weeks, the primary endpoint (cardiovascular death/non-fatal myocardial infarction (MI)/non-fatal stroke) was not significantly different in the treatment of T2DM patients with versus without DPP-4 inhibitors (OR: 0.95, 95% CI: 0.86-1.04; P = 0.26). Cardiovascular death (OR: 1.00, 95% CI: 0.90-1.10; P = 0.93), stroke (OR: 1.03, 95% CI: 0.89-1.18; P = 0.72), MI (OR: 0.97, 95% CI: 0.88-1.07; P = 0.59), all-cause mortality (OR: 0.84, 95% CI: 0.59-1.18; P = 0.31), hospitalization for cardiovascular complications (OR: 1.02, 95% CI: 0.96-1.09; P = 0.45) and hospitalization specifically for heart failure (OR: 1.05, 95% CI: 0.90-1.23; P = 0.55) were also similarly manifested in both groups. CONCLUSION The current analysis showed that treatment with DPP-4 inhibitors did not significantly increase cardiovascular outcomes in these patients with T2DM indicating that those drugs might be safe to use in terms of cardiovascular events.

中文翻译：

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二肽基肽酶4（DPP-4）抑制剂与2型糖尿病（T2DM）患者的心血管结局：系统评价和荟萃分析。

背景技术二肽基肽酶4（DPP-4）抑制剂是较新的口服抗糖尿病药，其已被食品和药物管理局批准用于治疗2型糖尿病（T2DM）患者。在这项分析中，我们旨在系统比较DPP-4抑制剂与非DPP-4抑制剂使用者的心血管结局。方法使用特定术语搜索所有比较DPP-4抑制剂使用情况和报告T2DM患者心血管结局的英文出版物。如果满足以下纳入标准，则将研究包括在内：他们是比较D2DM患者中DPP-4抑制剂使用的随机试验或观察队列/注册机构；这些研究包括大量参与者。他们报告心血管结局为主要终点。使用RevMan 5.3分析数据，并使用具有95％置信区间（CI）的比值比（OR）表示结果。结果包括157,478名T2DM参与者。DPP-4抑制剂组分为76,26例，对照组为81,452例。当前的分析结果表明，在平均随访时间（52至152周）内，治疗的主要终点（心血管死亡/非致命性心肌梗塞（MI）/非致命性中风）无显着差异有或没有DPP-4抑制剂的T2DM患者的比例（OR：0.95，95％CI：0.86-1.04； P = 0.26）。心血管死亡（OR：1.00，95％CI：0.90-1.10; P = 0.93），中风（OR：1.03，95％CI：0.89-1.18; P = 0.72），MI（OR：0.97，95％CI：0.88） -1.07; P = 0.59），全因死亡率（OR：0.84，95％CI：0.59-1.18； P = 0.31），因心血管并发症而住院的患者（OR：1.02，95％CI：0.96-1.09； P = 0.45），以及因心力衰竭而住院的患者（ OR：1.05，95％CI：0.90-1.23； P = 0.55）在两组中也相似。结论当前的分析表明，在这些T2DM患者中，用DPP-4抑制剂治疗不会显着增加心血管疾病的预后，表明就心血管事件而言，这些药物可能是安全的。