After the start was delayed by 30 minutes due to a lighting problem, Makarova and Vesnina began the first set by conceding two games.
But they fought back in a closely contested encounter which saw 14 break points and three match points.
Each time they pulled ahead, Mattek-Sands and Safarova caught up quickly.
But Makarova and Vesnina dug deep to take the first set on a tie break. They went on to dictate the second set and were handed the title due to a service error from Mattek-Sands.
Their victory in the season-ending tournament, open only to the top eight doubles pairs, rounds off a remarkable year in which they reached the finals of the French Open and won Olympic gold.
"This year for us is just amazing," Vesnina said.
The pair were presented with the Martina Navratilova Doubles Trophy at the Singapore Indoor Stadium by the tennis legend in person.
Makarova and Vesnina, who have been playing together since 2012, have seven doubles titles as a team, including the US Open in 2014 and the French Open in 2013.
Makarova is left-handed while Vesnina uses her right hand, a feature which Vesnina described as their winning combination.
"When we're motivated, ready and healthy, we're a very dangerous team," she said
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