Abstract
Inhibitors of dipeptidyl peptidase-4 (DPP-4) increase endogenous levels of glucagon-like peptide-1 (GLP-1) with subsequent stimulation of glucose-dependent secretion of insulin, decrease of excessive glucagon secretion thus leading to improved diabetes control. DPP-4 inhibitors are at present increasingly used in the treatment of type 2 diabetes owing to good efficacy and low risk of side effects.
In addition to treatment efficacy long-term safety of DPP-4 inhibitors has been discussed especially in relation to a possible increase of risk of malignancies, influence on immune system and a on a risk of heart failure. In this paper we focus on the clinical importance of DPP-4 inhibitor selectivity with respect to the risk of heart failure.
Numerous published studies confirm no increase in the risk of malignancies or clinically relevant influence on immune system in patients treated with DPP-4 inhibitors. A possibility of increased risk of heart failure suggested by some of the studies in patients with high cardiovascular risk is still a matter of an intensive research.
There is, however, no theoretical or clinical basis to suggest that the risk of heart failure is in any way connected to the selectivity of DPP-4 inhibitors.