Exploring the Role of Dipeptidyl Peptidase-4 (DPP-4) Inhibitors in the Management of Cardiogenic Shock: Pathophysiological Insights and Therapeutic Potential

Cardiogenic shock remains a critical condition characterized by profound myocardial dysfunction leading to end-organ hypoperfusion and high mortality rates despite advances in supportive therapies. While traditional management focuses on inotropes, vasopressors, and mechanical circulatory support, recent evidence suggests that metabolic modulation could provide additional benefits. Dipeptidyl peptidase-4 (DPP-4) inhibitors, primarily used in type 2 diabetes mellitus, have demonstrated cardioprotective effects through pleiotropic mechanisms, including anti-inflammatory, endothelial-protective, and metabolic-modulating actions. This review examines the potential utility of DPP-4 inhibitors in the context of cardiogenic shock, emphasizing their mechanisms of action, experimental and clinical data, and the feasibility of integrating these agents into the current therapeutic paradigm. We highlight gaps in knowledge and propose directions for future research to determine the clinical efficacy of DPP-4 inhibitors in this high-risk population.