Alogliptin decreases coronary plaque volume in ACS patients with dysglycemia

JAPAN: According to a study published in the Atherosclerosis Journal, alogliptin decreased coronary plaque volume in ACS patients with dysglycemia.

Typically, atherosclerotic plaque is believed to form gradually. Alogliptin is a DPP-4 selective inhibitor that has been given the go-ahead to treat type 2 diabetes. Dipeptidyl peptidase-4 inhibitors have anti-atherosclerotic properties, but these effects are still little understood, so the authors of this study set out to determine these effects.

66 patients with acute coronary syndrome (ACS) with mild dysglycemia (HbA1c 6.0 (5.7, 6.3) %, 58% of impaired glucose tolerance) were randomized to receive alogliptin (n = 33) or placebo (n = 33) in conjunction to usual therapies in a prospective, single-center, randomized trial. In order to assess changes in non-culprit lesions' plaque tissue components and coronary percent plaque volumes (%PV), serial intravascular ultrasonography (IVUS) was carried out at baseline and 10 months (NCLs).

Conclusive points of the study:

• Intensifications in HbA1c and lipid variables throughout a 10-month period, as well as baseline clinical and IVUS features, did not differ substantially between the 2 groups.
• Comparatively to the placebo group, the alogliptin group experienced significantly bigger reductions in plaque volumes (-0.3 0.6 vs. -0.04 0.7 mm3/mm, p = 0.03) and percent PV (-0.9 2.8 vs. 1.2 3.6%, p = 0.01), as well as a tendency toward less lumen loss (-0.1 0.7 vs. -0.4 0.8 mm3/mm, p = 0.07).
• At 10 months, the alogliptin group showed or tended to show significant reductions in percent necrotic volumes (%NV) (1.9 3.8 vs. 0.3 3.7%, p = 0.03) and increases in fibrotic volumes (2.5 5.0 vs. 0.3 5.3%, p = 0.05).
• Alogliptin use was a statistically significant predictor of changes in %PV ( β = 0.33, p = 0.004) and %NV (β = 0.28, p = 0.03) at 10 months in multiple regression analysis.

Patients with ACS and mild dysglycemia who were treated with analogliptin experienced significant plaque regression and stabilization in non-culprit lesions regardless of their glycemic and lipid conditions, highlighting the potential benefit of early incretin-based treatment for this patient population, concluded the authors.

REFERENCE

Okada, Kozo & Kikuchi, Shinnosuke & Kuji, & Nakayama, Naoki & Maejima, Nobuhiko & Matsuzawa, Yasushi & Iwahashi, Noriaki & Kosuge, Masami & Ebina, Toshiaki & Kimura, Kazuo & Tamura, Kouichi & Hibi, Kiyoshi. (2022). Impact of early intervention with alogliptin on coronary plaque regression and stabilization in patients with acute coronary syndromes. Atherosclerosis. 360. 10.1016/j.atherosclerosis.2022.09.005.