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Dapagliflozin confers more favorable cardiometabolic outcomes vs. vildagliptin

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CHICAGO — The SGLT2 inhibitor dapagliflozin was more beneficial than the DPP4 inhibitor vildagliptin in reducing BMI and systolic BP and improving other cardiometabolic outcomes among patients with type 2 diabetes and CAD, according to findings presented at the American Heart Association Scientific Sessions.

“SGLT2 inhibitors have been shown to reduce CV events and HF in type 2 diabetic patients with high CV risk,” Arintaya Phrommintikul, MD, of the department of internal medicine and the Cardiac Electrophysiology Research and Training Center at Chiang Mai University, and colleagues wrote in a poster presentation. “DPP4 inhibitors show neutral effects and may increase HF hospitalization. This study aimed to compare the cardiometabolic effects of dapagliflozin and vildagliptin in type 2 diabetes patients with coronary artery disease.”

Researchers conducted a randomized, double-blind, single-center study in which 43 patients with type 2 diabetes and CAD (mean age, 63 years; 52% men; mean left ventricular ejection fraction, 57%) were randomly assigned to receive either dapagliflozin (n = 21) or vildagliptin (n = 22) for 6 months.

A variety of cardiometabolic parameters, including HbA1c; BP; HDL and LDL; BMI; and hemoglobin levels, were taken at baseline and at the end of the treatments (mean baseline HbA1c, 8.18%; mean baseline systolic BP, 124.98 mm Hg; mean baseline HDL, 46.55 mg/dL; mean baseline LDL, 92.26 mg/dL; mean baseline BMI, 25.37 kg/m²; mean baseline hemoglobin, 12.30 g/dL).

Researchers found that, at 6 months, HbA1c decreased in both groups (dapagliflozin: mean change = -0.63; 95% CI, -1.10 to -0.16; vildagliptin: mean change = -0.84; 95% CI, -1.48 to -0.21; P = 0.22) and there was no difference between the changes in lipid profiles.

BMI decreased for patients receiving dapagliflozin (mean change = -0.49; 95% CI, -0.80 to -0.18), whereas it increased for patients receiving vildagliptin (mean change = 0.71; 95% CI, 0.30-1.12; P < .001).

In addition, researchers observed reductions in both systolic BP (mean change = -9.87; 95% CI, -18.00 to -1.75; P = 0.166) and high-sensitive troponin T (mean change = -2.49; 95% CI, -4.50 to -0.47; P = .002) and an increase in mean hemoglobin (mean change = 0.98; 95% CI, 0.54-1.42; P = .001) among participants receiving dapagliflozin.

For those taking vildagliptin, mean platelet volume increased (mean change = 0.64; 95% CI, 0.19-1.10; P = 0.011).

There was no significant change in inflammatory markers between the two groups, according to the researchers.

“The extra-glycemic effects of dapagliflozin and vildagliptin on cardiometabolic parameters in type 2 diabetes and CAD were different,” the researchers wrote. “The more favorable effects of dapagliflozin compared to vildagliptin may have explained the cardiovascular benefits observed only in [the] SGLT2 inhibitor.” – by Melissa J. Webb

Reference: Phrommintikul A, et al. Abstract 1004. Presented at: American Heart Association Scientific Sessions; Nov. 10-12, 2018; Chicago.

Disclosure: The authors report no relevant financial disclosures.