Key result
Saxagliptin 5 mg daily had neutral effects on cardiovascular parameters in obese patients with IGT, except for a more marked post-prandial depression of cardiac vagal activity (p=0.016).
Why the study?
Studies of DPP4 inhibitors report heterogeneous effects on cardiovascular targets in type 2 diabetes, leaving unclear whether saxagliptin has beneficial cardiovascular effects at fasting and post-prandially in patients with impaired glucose tolerance.
Does saxagliptin improve cardiovascular targets at fasting and post-prandially in obese patients with impaired glucose tolerance?
RCT
Placebo-controlled
Randomized
Does saxagliptin improve cardiovascular targets at fasting and post-prandially in obese patients with impaired glucose tolerance?
p-value: p=0.016
Saxagliptin has neutral effects on cardiovascular and hemodynamic parameters in obese patients with impaired glucose tolerance, but may cause a more marked post-prandial depression of vagal activity.
Saxagliptin shows largely neutral cardiovascular effects in obese IGT patients; reinforces DPP4i safety consensus from larger T2D trials.
BACKGROUND AND AIMS: Studies of dipeptidyl peptidase inhibitors (DPP4is) report heterogeneous effects on cardiovascular targets in type 2 diabetes. This study aimed to investigate, in patients with impaired glucose tolerance (IGT), whether saxagliptin, a DPP4i, had beneficial cardiovascular effects at fasting and during the post-prandial state. METHODS AND RESULTS: ) were randomized to receive for 12 weeks either saxagliptin 5 mg a day or placebo. They were explored before and after a standardized breakfast for biological markers; microcirculatory blood flow at baseline and after transcutaneous administration of acetylcholine (Periflux System 5000® PERIMED); post-occlusive digital reactive hyperhemia (Endopat2000®); pulse wave velocity, augmentation index, central pulse pressure and subendocardial viability ratio (Sphygmocor®); cardiac hemodynamic parameters and cardiovascular autonomic nervous system activity (Task force monitor®). The results of all the investigations were similar after breakfast in the two groups at Visit 1 (acute post-prandial effects, after the first tablet) and Visit 2 (long-term post-prandial effects), and at fasting at Visit 1 and 2 (long-term effects, after 12 weeks of treatment). Only at Visit 2 the decrease in cardiac vagal activity occurring after breakfast was more sustained in the saxagliptin group than in the placebo group (interaction between treatment and time effect: p = 0.016). CONCLUSION: In obese patients with IGT, the effects of saxagliptin on the large set of cardiovascular parameters measured are neutral, except for a more marked post-prandial depression of vagal activity. CLINICAL TRIAL REGISTRATION NUMBER: NCT01521312.
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Rezki et al. (2021) conducted an RCT in Obese patients with impaired glucose tolerance. Saxagliptin vs. Placebo was evaluated on Cardiovascular targets including microcirculatory blood flow, pulse wave velocity, and autonomic nervous system activity (p=0.016). Saxagliptin 5 mg daily had neutral effects on cardiovascular parameters in obese patients with IGT, except for a more marked post-prandial depression of cardiac vagal activity (p=0.016).
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