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However, DPP-4 inhibitors have not reduced the risk of major adverse cardiovascular events, possibly because potentiation of SDF-1 enhances plaque growth and instability, activates deleterious neurohormonal mechanisms, and promotes cardiac inflammation and fibrosis

Catecholamine Cascade : Once L-DOPA is formed, it converts to dopamine through aromatic L-amino acid decarboxylase, then proceeds to neurotransmitter norepinephrine via dopamine beta-hydroxylase, and finally to epinephrine in adrenal tissues