95bff47d893ee113578d05d8d2eae06d medicina-60-01986.pdf 8897c6011f065d93e4896608979d656c1f429ddc medicina-60-01986.pdf f1e0568eb35245cd592f6678a391dd2f7b1cc7a74a042a2c7a6b79b283275444 medicina-60-01986.pdf Title: Impact of DPP-4 Inhibitors in Patients with Diabetes Mellitus and Heart Failure: An In-Depth Review Subject: The increasing prevalence of both type 2 diabetes mellitus and heart failure has underscored the urgent need for optimized therapeutic strategies that address the complex interplay between these conditions. Dipeptidyl peptidase-4 (DPP-4) inhibitors have emerged as a popular class of glucose-lowering agents due to their favorable glycemic effects, safety profile, and potential cardiovascular benefits. However, the impact of DPP-4 inhibitors on heart failure outcomes in patients with diabetes remains contentious, with conflicting evidence from clinical trials and observational studies. This review critically examines current evidence on the use of DPP-4 inhibitors in patients with coexisting diabetes and heart failure, focusing on pharmacodynamics, safety, and efficacy outcomes. We explore the physiological mechanisms by which DPP-4 inhibitors may influence heart failure risk, including modulation of inflammation, oxidative stress, and myocardial fibrosis. Clinical trials such as SAVOR-TIMI 53, EXAMINE, and TECOS are evaluated to provide a comprehensive analysis of DPP-4 inhibitors’ effects on hospitalization for heart failure, mortality, and cardiovascular events in diabetic patients. While some trials suggest an increased risk of HF hospitalizations with specific DPP-4 inhibitors (e.g., saxagliptin), others report neutral effects, raising questions about the class effects versus individual drug characteristics within this group. Additionally, we address discrepancies in outcomes related to patient demographics, HF phenotype, and comorbid conditions that may influence DPP-4 inhibitors’ risk–benefit profile. Comparative insights into alternative glucose-lowering therapies such as SGLT2 inhibitors and GLP-1 receptor agonists are also provided, highlighting potential implications for treatment selection in this high-risk population. In summary, this review synthesizes available evidence on DPP-4 inhibitors’ impact in diabetic patients with heart failure, aiming to guide clinicians in making informed therapeutic decisions. While DPP-4 inhibitors remain a viable option in diabetes management, caution is warranted in patients with advanced heart failure, and future research is essential to refine patient-specific guidelines. Keywords: heart failure; diabetes mellitus; DDP-4 inhibitors Author: Francisco Epelde Creator: LaTeX with hyperref Producer: pdfTeX-1.40.25 CreationDate: Mon Dec 2 09:16:14 2024 CET ModDate: Mon Dec 2 09:18:23 2024 CET Custom Metadata: no Metadata Stream: no Tagged: no UserProperties: no Suspects: no Form: none JavaScript: no Pages: 26 Encrypted: no Page size: 595.276 x 841.89 pts (A4) Page rot: 0 File size: 411113 bytes Optimized: no PDF version: 1.7 name type encoding emb sub uni object ID ------------------------------------ ----------------- ---------------- --- --- --- --------- OPZDHV+VnURWPalladioL Type 1 Custom yes yes yes 10 0 RTKLDW+URWPalladioL-Bold Type 1 Custom yes yes yes 16 0 YGXNZW+URWPalladioL-Roma Type 1 Custom yes yes yes 22 0 QTXPCU+URWPalladioL-Ital Type 1 Custom yes yes yes 27 0 QDCWHF+EURM10 Type 1 Builtin yes yes yes 63 0 Jhove (Rel. 1.28.0, 2023-05-18) Date: 2025-02-18 02:44:43 CET RepresentationInformation: medicina-60-01986.pdf ReportingModule: PDF-hul, Rel. 1.12.4 (2023-03-16) LastModified: 2025-02-12 10:29:20 CET Size: 411113 Format: PDF Version: 1.7 Status: Well-Formed and valid SignatureMatches: PDF-hul MIMEtype: application/pdf PDFMetadata: Objects: 497 FreeObjects: 1 IncrementalUpdates: 0 DocumentCatalog: PageLayout: SinglePage PageMode: UseNone Outlines: Item: Title: Introduction Destination: section.1 Item: Title: Physiopathology of Diabetes, Heart Failure, and DPP-4 Inhibitors Destination: section.2 Item: Title: Mechanisms of Action of DPP-4 Inhibitors and Their Implications in Heart Failure Destination: section.3 Item: Title: Clinical Efficacy and Safety of DPP-4 Inhibitors in Heart Failure Patients Destination: section.4 Item: Title: Comparative Analysis of DPP-4 Inhibitors and Other Antidiabetic Treatments in Heart Failure Destination: section.5 Item: Title: Special Populations: Older Adults, Renal Insufficiency, and Other Considerations Destination: section.6 Item: Title: Differences Within the DPP-4 Inhibitor Class: Saxagliptin, Alogliptin, Sitagliptin, and Linagliptin Destination: section.7 Item: Title: Future Lines of Study Destination: section.8 Item: Title: Conclusions Destination: section.9 Item: Title: References Destination: section.10 Info: Title: Impact of DPP-4 Inhibitors in Patients with Diabetes Mellitus and Heart Failure: An In-Depth Review Author: Francisco Epelde Subject: The increasing prevalence of both type 2 diabetes mellitus and heart failure has underscored the urgent need for optimized therapeutic strategies that address the complex interplay between these conditions. Dipeptidyl peptidase-4 (DPP-4) inhibitors have emerged as a popular class of glucose-lowering agents due to their favorable glycemic effects, safety profile, and potential cardiovascular benefits. However, the impact of DPP-4 inhibitors on heart failure outcomes in patients with diabetes remains contentious, with conflicting evidence from clinical trials and observational studies. This review critically examines current evidence on the use of DPP-4 inhibitors in patients with coexisting diabetes and heart failure, focusing on pharmacodynamics, safety, and efficacy outcomes. We explore the physiological mechanisms by which DPP-4 inhibitors may influence heart failure risk, including modulation of inflammation, oxidative stress, and myocardial fibrosis. Clinical trials such as SAVOR-TIMI 53, EXAMINE, and TECOS are evaluated to provide a comprehensive analysis of DPP-4 inhibitors’ effects on hospitalization for heart failure, mortality, and cardiovascular events in diabetic patients. While some trials suggest an increased risk of HF hospitalizations with specific DPP-4 inhibitors (e.g., saxagliptin), others report neutral effects, raising questions about the class effects versus individual drug characteristics within this group. Additionally, we address discrepancies in outcomes related to patient demographics, HF phenotype, and comorbid conditions that may influence DPP-4 inhibitors’ risk benefit profile. Comparative insights into alternative glucose-lowering therapies such as SGLT2 inhibitors and GLP-1 receptor agonists are also provided, highlighting potential implications for treatment selection in this high-risk population. In summary, this review synthesizes available evidence on DPP-4 inhibitors’ impact in diabetic patients with heart failure, aiming to guide clinicians in making informed therapeutic decisions. While DPP-4 inhibitors remain a viable option in diabetes management, caution is warranted in patients with advanced heart failure, and future research is essential to refine patient-specific guidelines. 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Subtype: Link Rect: 147, 627, 183, 637 Annotation: Subtype: Link Rect: 292, 591, 330, 602 Annotation: Subtype: Link Rect: 336, 591, 372, 602 Annotation: Subtype: Link Rect: 378, 591, 446, 602 Annotation: Subtype: Link Rect: 104, 558, 142, 568 Annotation: Subtype: Link Rect: 148, 558, 184, 568 Annotation: Subtype: Link Rect: 118, 535, 155, 545 Checksum: a6ea934d Type: CRC32 Checksum: 95bff47d893ee113578d05d8d2eae06d Type: MD5 Checksum: 8897c6011f065d93e4896608979d656c1f429ddc Type: SHA-1 Checksum: f1e0568eb35245cd592f6678a391dd2f7b1cc7a74a042a2c7a6b79b283275444 Type: SHA-256