Effect of Dipeptidyl Peptidase-4 Inhibitors on Cardiovascular Risk in Type-2 Diabetes Mellitus:A Meta-analysis

Objective To systematically evaluate the safety of dipeptidyl peptidase-4(DPP-4) inhibitors on the risk of cardiovascular events in type 2 diabetes mellitus(T2DM) patients. Methods Databases such as the Cochrane Library,Pub Med,Elsevier Science Direct and EMbase were searched to collect randomized controlled trials(RCTs) about DPP-4 inhibitors for T2 DM patients from inception to February 2014. Two reviewers independently screened literature according to the inclusion and exclusion criteria,extracted data and assessed the methodological quality of included studies. Then,meta-analysis was performed using Rev Man5.2 software. Results A total of 20 RCTs involving 10 402 patients were included. The results of meta-analysis showed that: there were no significant differences between the DPP-4 inhibitors group and the control group in the cardiovascular adverse events(RR=0.86,95%CI 0.62 to 1.20,P=0.38) and acute coronary syndrome(RR=0.66,95%CI 0.37 to 1.17,P=0.15). Subgroup analyses by type of liptins and durations showed there were lower risks of adverse cardiovascular events in the DPP-4 inhibitors group of the sitagliptin subgroup(RR=0.49,95%CI 0.29 to 0.82,P=0.007) and the duration of ≥ 52 weeks subgroup(RR=0.62,95%CI 0.39 to 0.97,P=0.04). No significant difference was found between the two groups in hypertension events(RR=1.09,95%CI 0.84 to 1.40,P=0.52). Conclusion The DPP-4 inhibitors are relatively safe. In the long-term treatment of T2 DM,the sitagliptin could not only effectively control the level of blood sugar but also might obtain benefits in cardiovascular aspects.