DPP4 and myocardial infarction: More importantly, large randomized clinical trials (RCTs) on the cardiovascular outcomes of DPP4 inhibitors (DPP4is) have further failed to support any favorable cardiovascular effects of lower DPP4 levels, demonstrating only a noninferior risk of a composite CV outcome (CV death, nonfatal myocardial infarction, or nonfatal stroke) in diabetic patients with established cardiovascular disease [31].