Acute myocardial infarction associated to DPP-4 inhibitors

INTRODUCTION Diabetes mellitus is associated with cardiovascular disease. Anti-diabetic therapy has a limited capability (if any) of changing the incidence of either death or major cardiovascular disease, and cardiovascular safety concerns have been raised. We aimed at identifying episodes of acute myocardial infarction associated to a relatively new class of drugs, dipeptidyl peptidase-4 inhibitors. METHODS Retrospective study: from 954 admissions (15 month period) in the coronary care unit, we selected 200 admissions corresponding to 196 patients with myocardial infarction and diabetes. 35 of these patients were receiving therapy with dipeptidyl peptidase-4 inhibitors (the vast majority, in association to metformin). We evaluated the peak plasma cardiac troponin I as the main study parameter. RESULTS Patients on dipeptidyl peptidase-4 inhibitors therapy had a mean peak cardiac troponin plasma level of 50.2±121.3 ng/ml (n=35), the corresponding value for insulin being 39.2±108.4 ng/ml (n=56), for metformin the value was 45.8±97.3 ng/ml (n=93) and for sulfonylureas, 42.4±77.7 ng/ml (n=52). None of these values differed significantly from the corresponding control group of patients not taking each class of drug. The linear regression study also yielded a negative result relating therapy with dipeptidyl peptidase-4 inhibitors and peak troponin values. Acute myocardial infarctions associated to dipeptidyl peptidase-4 inhibitors varied widely in the clinical characteristics of the patients. CONCLUSIONS We found no evidence that peak plasma troponin I was different between patient with acute myocardial infarction and use of dipeptidyl peptidase-4 inhibitors when compared to cases not under such therapy.