Dipeptidyl peptidase-4 inhibitors and their potential role in the management of atherosclerosis—A review

BackgroundDipeptidyl peptidase-4 (DPP-4) inhibitors are a relatively new class of anti-diabetic drugs that have therapeutic potential in the management of atherosclerosis. Of the numerous DPP-4 inhibitors in clinical practice no studies have been conducted to compare their anti-atherosclerotic effects despite growing evidence of their usefulness in the high risk population.ObjectiveThe aim of the study was to review the anti-athero-thrombotic effects of DPP-4 inhibitors in atherosclerotic diseases.MethodA literature search was conducted on MEDLINE and the COCHRANE Library using the terms “DPP-4 Inhibitors”, “atherosclerosis”, “GLP”, “inflammation”, “cytokines”, “stroke”, “ischaemic heart disease”, “hypertension” and “peripheral vascular disease”. A mathematical model devised by us was used to derive and compare the anti-inflammatory effects of the DPP-4 inhibitors using protective score [PS]. Data was analysed for alogliptin, linagliptin, saxagliptin, sitagliptin, and vildagliptin.ResultsSixty two published studies collected in the search were assessed for relevance to this study. Sitagliptin had the highest PS [n = 5] while linagliptin and saxagliptin yielded the lowest PS [n = 1]. This comparison and scoring system was limited to the data collected; which did not investigate for all athero-thrombotic factors selected in this study.ConclusionThe findings suggest potential usefulness of DPP-4 in atherosclerotic diseases. It also reflected a possible superiority of sitagliptin over the other DPP-4 inhibitors in the management of atherosclerosis. Further investigations are required to establish specific inflammatory cytokines influenced by the DPP-4 inhibitors and to elucidate their clinical application in athero-thrombotic disease.