DPP-4 Inhibitors: Navigating the Intersection of Heart Health, Kidney Function, and Diabetes Management

A special issue of Medicina (ISSN 1648-9144). This special issue belongs to the section "Cardiology".

Deadline for manuscript submissions: 31 May 2025 | Viewed by 3831

Special Issue Editor


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Guest Editor
Internal Medicine Department, Hospital de Sabadell, University Autonoma of Barcelona, 08208 Barcelona, Spain
Interests: heart failure; atrial fibrillation; ischemic cardiopathy; hospital administration; cardiovascular risk; lipidology
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Special Issue Information

Dear Colleagues,

The Special Issue titled "DPP-4 Inhibitors: Navigating the Intersection of Heart Health, Kidney Function, and Diabetes Management" focuses on the multifaceted role of Dipeptidyl Peptidase-4 (DPP-4) inhibitors in treating not only diabetes but also heart failure and kidney insufficiency. Originally designed to manage blood glucose levels in patients with type 2 diabetes, DPP-4 inhibitors have gained attention for their potential benefits in non-diabetic populations, particularly those with cardiovascular and renal conditions.

This Issue will explore the broader implications of DPP-4 inhibitors beyond glycemic control, examining their effects on heart and kidney health. Recent studies have shown that these drugs may help reduce the risk of heart failure and slow the progression of chronic kidney disease, even in non-diabetic patients. The Special Issue aims to highlight these emerging roles and discuss the mechanisms by which DPP-4 inhibitors exert protective effects on cardiovascular and renal systems, such as through anti-inflammatory and endothelial-regulating pathways.

Key topics include the use of DPP-4 inhibitors in heart failure management, where they have shown promise in reducing hospitalizations and improving heart function. Additionally, the Issue will cover their role in kidney insufficiency, focusing on how these agents can help delay the progression of diabetic and non-diabetic nephropathy. This comprehensive review will provide healthcare professionals with a deeper understanding of how to utilize DPP-4 inhibitors in a variety of clinical settings, enhancing treatment strategies for patients with or without diabetes who are at risk for cardiovascular and renal complications.

Dr. Francisco Epelde
Guest Editor

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Keywords

  • DPP-4 inhibitors
  • heart failure
  • kidney insufficiency
  • cardiovascular health
  • diabetes management
  • non-diabetic patients
  • endothelial regulation
  • inflammation modulation
  • chronic kidney disease
  • nephropathy

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Published Papers (2 papers)

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Editorial

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4 pages, 239 KiB  
Editorial
Transforming Diabetes Care: The Expanding Role of DPP-4 Inhibitors in Cardiovascular and Renal Protection
by Francisco Epelde
Medicina 2024, 60(11), 1793; https://doi.org/10.3390/medicina60111793 - 1 Nov 2024
Cited by 1 | Viewed by 1549
Abstract
The approach to managing type 2 diabetes mellitus (T2DM) has significantly progressed, evolving beyond strict glycemic control to addressing the wider complications associated with the disease, including cardiovascular disease (CVD) and chronic kidney disease (CKD) [...] Full article

Review

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26 pages, 401 KiB  
Review
Impact of DPP-4 Inhibitors in Patients with Diabetes Mellitus and Heart Failure: An In-Depth Review
by Francisco Epelde
Medicina 2024, 60(12), 1986; https://doi.org/10.3390/medicina60121986 - 2 Dec 2024
Cited by 2 | Viewed by 1873
Abstract
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 [...] Read more.
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. Full article
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