Most individuals with
type 2 diabetes mellitus have or will develop multiple independent risk factors for cardiovascular disease, particularly
coronary artery disease (CAD). CAD is the leading cause of morbidity and mortality among individuals with
type 2 diabetes mellitus, and treating these patients is challenging. The risk of
hypoglycemia,
weight gain, or fluid retention with some diabetes medications should be considered when developing a treatment plan for individuals with a history of CAD or at risk for CAD. Dipeptidyl peptidase-4 inhibitors are oral
antihyperglycemic agents that inhibit the breakdown of the
incretin hormones glucagon-like peptide-1 and
glucose-dependent insulinotropic
polypeptide, resulting in increased
glucose-dependent insulin secretion and suppression of
glucagon secretion.
Saxagliptin is a potent and selective dipeptidyl peptidase-4 inhibitor that improves
glycemic control and is generally well tolerated when used as monotherapy and as add-on
therapy to other
antihyperglycemic medications. This review summarizes findings from recently published post hoc analyses of
saxagliptin clinical trials that have been conducted in patients with and without a history of
cardiovascular disease and in patients with and without various risk factors for cardiovascular disease. The results show that
saxagliptin was generally well tolerated and consistently improved
glycemic control, as assessed by reductions from baseline in
glycated hemoglobin, fasting plasma
glucose concentration, and postprandial
glucose concentration, regardless of the presence or absence of baseline
cardiovascular disease,
hypertension,
statin use, number of cardiovascular risk factors, or high Framingham 10-year cardiovascular risk score.