Effect of dipeptidyl peptidase-4 inhibitor on the progression of coronary artery disease evaluated by computed tomography in patients receiving insulin therapy for type 2 diabetes mellitus

Abstract

Abstract Background: We evaluated the effect of a dipeptidyl peptidase-4 inhibitor (DPP-4i) on the progression of obstructive coronary artery disease (OCAD) in patients with type 2 diabetes mellitus (T2DM) receiving insulin therapy. Methods: Using a multi-center clinical data warehouse, we retrospectively analyzed the patients receiving insulin therapy for T2DM who underwent coronary computed tomography angiography (CCTA) ≥2 times. The patients were divided into two groups according to the presence of DPP-4i prescription between the two CCTA examinations. The prevalence of OCAD (defined as >50% stenosis on CCTA), new revascularization rates, and changes in the coronary calcium score (CCS) were compared between the two groups. Results: A total of 623 patients were included and a DPP-4i was prescribed to 380 (60.9%) patients. The median time difference between the two CCTAs was 39.0 (17.0–61.4) months. Newly developed OCAD at the follow-up CCTA was detected in 62 (16.3%) patients in the DPP-4i group and 76 (31.3%) patients in the no DPP-4i group (p<0.001). The risk of new OCAD or new revascularization was lower in the DPP-4i group (19.7% vs. 38.7%, p<0.001). After propensity score matching, the prevalence of new OCAD (15.9% vs. 29.5%, p=0.001) and the composite rate of new OCAD or new revascularization (18.7% vs. 37.3%, p<0.001) were lower in the DPP-4i group. The change in CCS per year did not differ significantly between the two groups (9.1 [0.1 – 56.8] vs. 13.5 [0.0 – 78.6], p=0.715). Conclusion: Add-on DPP-4i therapy would be beneficial in preventing coronary artery disease progression in patients with T2DM receiving insulin therapy. Trial registration: ClinicalTrials.gov, study number NCT04825795