Physicians' Academy for Cardiovascular Education

DPP-4 inhibition may reduce carotid atherosclerosis in T2DM patients in primary prevention

Sitagliptin on carotid intima-media thickness in type 2 diabetes patients receiving primary or secondary prevention of cardiovascular disease: A subgroup analysis of the PROLOGUE study

Literature - Tanaka A, Yoshida H, Nanasato M, et al. - Int J Cardiol 2018; published online ahead of print

Introduction and methods

Studies evaluating the ability of dipeptidyl peptidase-4 (DPP-4) inhibitors to decrease carotid intima-media thickness (IMT) have come to conflicting results [1-3]. A reasonable explanation for this might be that relevant studies enrolled different types of type 2 diabetes mellitus (T2DM) patients; the PROLOGUE study [1] enrolled patients with and without established CVD, whereas others included only those without CV events.

In this post hoc analysis of the PROLOGUE study [1], it was evaluated whether the effect of sitaglitin on carotid atherosclerosis differed between primary and secondary prevention groups.

PROLOGUE was a 2-year, prospective, randomized, open-label study, comparing the effect of sitagliptin with standard of care on carotid IMT progression in 442 T2DM patients. In this subanalysis of the study, the effect on sitagliptin and conventional therapy on changes in carotid -IMT measurements at 24 months were compared, in groups stratified according to presence or absence of previous CV events.

Main results


DPP-4 inhibition with sitagliptin for 24 months decreased ICA-IMT in T2DM patients in primary prevention, although it did not decrease CCA-IMT neither in primary, nor in secondary prevention.


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