The impact of vildagliptin on the daily glucose profile and coronary plaque stability in impaired glucose tolerance patients with coronary artery disease: VOGUE—A multicenter randomized controlled trial

Abstract

Background The impact of reduction in glycemic excursion on coronary plaques remains unknown. This study aimed to elucidate whether a dipeptidyl peptidase 4 inhibitor could reduce the glycemic excursion and stabilize the coronary plaques compared with conventional management in coronary artery disease (CAD) patients with impaired glucose tolerance (IGT). Methods This was a multicenter, randomized controlled trial including CAD patients with IGT under lipid-lowering therapy receiving either vildagliptin (50 mg once a day) or no medication (control group) regarding glycemic treatment. The primary endpoint was changes in the minimum fibrous cap thickness and lipid arc in non-significant native coronary plaques detected by optical coherence tomography at 6 months after intervention. Glycemic variability expressed as the mean amplitude of glycemic excursion (MAGE) measured with a continuous glucose monitoring system was evaluated before and 6 months after intervention. Results A total of 20 participants with 47 lesions were allocated to either the vildagliptin group (10 participants, 22 lesions) or the control group (10 participants, 25 lesions). The adjusted difference of mean changes between the groups was − 18.8 mg/dl (95% confidence interval, − 30.8 to − 6.8) (p = 0.0064) for the MAGE (vildagliptin, − 20.1 ± 18.0 mg/dl vs. control, 2.6 ± 12.7 mg/dl), − 22.8° (− 40.6° to − 5.1°) (p = 0.0012) for the mean lipid arc (vildagliptin, − 9.0° ± 25.5° vs. control, 15.8° ± 16.8°), and 42.7 μm (15.3 to 70.1 μm) (p = 0.0022) for the minimum fibrous cap thickness (vildagliptin, 35.7 ± 50.8 μm vs. control, − 15.1 ± 25.2 μm). Conclusions Vildagliptin could reduce the MAGE at 6 months and may be associated with the decreased lipid arc and increased minimum FCT of the coronary plaques in CAD patients with IGT as compared with the control group. These findings may represent its potential stabilization effect on coronary plaques, which are characteristic in this patient subset. Trial registration Registered in the UMIN clinical trial registry (UMIN000008620), Name of the registry: VOGUE trial, Date of registration: Aug 6, 2012, URL: https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000010058

Acute Coronary Syndrome Due to Intraplaque Hemorrhage in a Post-gastrectomy Patient with a Latent Severe Glycemic Disorder

“…For patients with glycemic disorder but without diabetes, nutritional therapy is recommended. Moreover, several randomized trials have suggested that early intervention for impaired glucose tolerance with medications, such as alfa-glucosidase inhibitors or dipeptidyl peptidase-4 inhibitor, for decreasing post-prandial hyperglycemia, may improve both plaque stability and hypoglycemia ( 13 , 14 ). Future large-scale clinical trials to determine whether early intervention for glycemic disorder may improve the cardiovascular outcomes should therefore be conducted.…”

Effects of Vildagliptin, a Dipeptidyl Peptidase-4 Inhibitor, on the Parameters of Glucose Metabolism and the Cardio-Ankle Vascular Index in Individuals with Type 2 Diabetes

“…This may be because vildagliptin exerts a higher inhibitory effect on DPP-4 activity than sitagliptin [17]. The significance of vildagliptin monotherapy has been reviewed [18], and vildagliptin has even been shown to exert a stabilization effect on coronary plaques [19]. Furthermore, the additional efficacy of vildagliptin has also been reported in individuals with type 2 diabetes which is inadequately controlled by sulfonylureas [20] or biguanides [21].…”

Effect of vildagliptin, a dipeptidyl peptidase-4 inhibitor, on parameters of glucose metabolism and cardio-ankle vascular index (CAVI) in individuals with type 2 diabetes

“…17 The signi cance of vildagliptin monotherapy has been reviewed 18 , and vildagliptin has even been known to exert the stabilization effect on coronary plaques. 19 On the other hand, the effect of vildagliptin on CAVI has been not clari ed.…”