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Dipeptidyl peptidase-4 inhibitors and cardiovascular risks in patients with pre-existing heart failure.
Heart. 2017 03; 103(6):414-420.H

Abstract

BACKGROUND

Although recent clinical trials raised concerns about the risk for heart failure (HF) in dipeptidyl peptidase-4 (DPP-4) inhibitor use, data on the cardiovascular risks in the patients with pre-existing HF are still lacking.

METHODS

We used Taiwan's National Health Insurance Research Database to identify 196 986 patients diagnosed with type 2 diabetes mellitus (T2DM) who had previous history of HF between 2009 and 2013. This population included 30 204 DPP-4 inhibitor users and 166 782 propensity score-matched DPP-4 inhibitor non-users. The outcomes of interest were all-cause mortality, combination of myocardial infarction (MI) and ischaemic stroke, and hospitalisation for HF.

RESULTS

The incidence in DPP-4 users compared with non-users was 67.02 vs 102.85 per 1000 person-years for all-cause mortality, 37.89 vs 47.54 per 1000 person-years for the combination of MI and ischaemic stroke, 12.70 vs 16.18 per 1000 person-years for MI and 26.37 vs 32.46 per 1000 person-years for ischaemic stroke. The risk of all-cause mortality was lower in DPP-4 inhibitor users (HR 0.67, 95% CI 0.64 to 0.70), combination of MI and stroke (HR 0.81, 95% CI 0.76 to 0.87), MI (HR 0.80, 95% CI 0.71 to 0.89) and ischaemic stroke (HR 0.83, 95% CI 0.76 to 0.89) than in non-users. Notably, the risk of hospitalisation for HF did not differ significantly between groups. The results were similar after accounting for death as a competing risk.

CONCLUSIONS

In this nationwide T2DM cohort, the risks of mortality and the combination of MI and ischaemic stroke were lower for patients receiving DPP-4 inhibitors than for those who did not receive such treatment. DPP-4 inhibitor use was not associated with a higher risk of hospitalisation for HF even in patients with pre-existing HF.

Authors+Show Affiliations

Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan. School of Medicine, National Yang-Ming University, Taipei, Taiwan.School of Medicine, National Yang-Ming University, Taipei, Taiwan. Division of Endocrinology and Metabolism, Department of Medicine, Taipei City Hospital, Heping Fuyou Branch, Taipei, Taiwan.School of Medicine, National Yang-Ming University, Taipei, Taiwan. Division of Infectious Diseases, Taipei Veterans General Hospital, Taipei, Taiwan. National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Miaoli County, Taiwan.Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.School of Medicine, National Yang-Ming University, Taipei, Taiwan. Department of Medicine, Taipei Veterans General Hospital, Yuanshan Branch, Yilan, Taiwan.School of Medicine, National Yang-Ming University, Taipei, Taiwan. Division of Nephrology, Department of Medicine, Taipei City Hospital, Heping Fuyou Branch, Taipei, Taiwan.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

27647170

Citation

Ou, Shuo-Ming, et al. "Dipeptidyl Peptidase-4 Inhibitors and Cardiovascular Risks in Patients With Pre-existing Heart Failure." Heart (British Cardiac Society), vol. 103, no. 6, 2017, pp. 414-420.
Ou SM, Chen HT, Kuo SC, et al. Dipeptidyl peptidase-4 inhibitors and cardiovascular risks in patients with pre-existing heart failure. Heart. 2017;103(6):414-420.
Ou, S. M., Chen, H. T., Kuo, S. C., Chen, T. J., Shih, C. J., & Chen, Y. T. (2017). Dipeptidyl peptidase-4 inhibitors and cardiovascular risks in patients with pre-existing heart failure. Heart (British Cardiac Society), 103(6), 414-420. https://doi.org/10.1136/heartjnl-2016-309687
Ou SM, et al. Dipeptidyl Peptidase-4 Inhibitors and Cardiovascular Risks in Patients With Pre-existing Heart Failure. Heart. 2017;103(6):414-420. PubMed PMID: 27647170.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Dipeptidyl peptidase-4 inhibitors and cardiovascular risks in patients with pre-existing heart failure. AU - Ou,Shuo-Ming, AU - Chen,Hung-Ta, AU - Kuo,Shu-Chen, AU - Chen,Tzeng-Ji, AU - Shih,Chia-Jen, AU - Chen,Yung-Tai, Y1 - 2016/09/19/ PY - 2016/04/01/received PY - 2016/08/08/revised PY - 2016/08/15/accepted PY - 2016/9/21/pubmed PY - 2017/7/25/medline PY - 2016/9/21/entrez SP - 414 EP - 420 JF - Heart (British Cardiac Society) JO - Heart VL - 103 IS - 6 N2 - BACKGROUND: Although recent clinical trials raised concerns about the risk for heart failure (HF) in dipeptidyl peptidase-4 (DPP-4) inhibitor use, data on the cardiovascular risks in the patients with pre-existing HF are still lacking. METHODS: We used Taiwan's National Health Insurance Research Database to identify 196 986 patients diagnosed with type 2 diabetes mellitus (T2DM) who had previous history of HF between 2009 and 2013. This population included 30 204 DPP-4 inhibitor users and 166 782 propensity score-matched DPP-4 inhibitor non-users. The outcomes of interest were all-cause mortality, combination of myocardial infarction (MI) and ischaemic stroke, and hospitalisation for HF. RESULTS: The incidence in DPP-4 users compared with non-users was 67.02 vs 102.85 per 1000 person-years for all-cause mortality, 37.89 vs 47.54 per 1000 person-years for the combination of MI and ischaemic stroke, 12.70 vs 16.18 per 1000 person-years for MI and 26.37 vs 32.46 per 1000 person-years for ischaemic stroke. The risk of all-cause mortality was lower in DPP-4 inhibitor users (HR 0.67, 95% CI 0.64 to 0.70), combination of MI and stroke (HR 0.81, 95% CI 0.76 to 0.87), MI (HR 0.80, 95% CI 0.71 to 0.89) and ischaemic stroke (HR 0.83, 95% CI 0.76 to 0.89) than in non-users. Notably, the risk of hospitalisation for HF did not differ significantly between groups. The results were similar after accounting for death as a competing risk. CONCLUSIONS: In this nationwide T2DM cohort, the risks of mortality and the combination of MI and ischaemic stroke were lower for patients receiving DPP-4 inhibitors than for those who did not receive such treatment. DPP-4 inhibitor use was not associated with a higher risk of hospitalisation for HF even in patients with pre-existing HF. SN - 1468-201X UR - https://www.unboundmedicine.com/medline/citation/27647170/Dipeptidyl_peptidase_4_inhibitors_and_cardiovascular_risks_in_patients_with_pre_existing_heart_failure_ L2 - https://heart.bmj.com/lookup/pmidlookup?view=long&pmid=27647170 DB - PRIME DP - Unbound Medicine ER -