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Cardiovascular events associated with second-line anti-diabetes treatments: analysis of real-world Korean data.
Diabet Med. 2017 09; 34(9):1235-1243.DM

Abstract

AIM

To compare the risks of cardiovascular disease (CVD) and all-cause mortality associated with sulfonylurea (SU), dipeptidyl peptidase-4 inhibitor (DPP4i) and thiazolidinedione (TZD) as add-on medications to metformin (MET) therapy in people with Type 2 diabetes.

METHODS

We identified 40 263 individuals who used SU (n = 11 582), DPP4i (n = 26 623) or TZD (n = 2058) in addition to MET between January 2013 and June 2015 from the database of the Korean National Health Insurance, the single-payer healthcare system in South Korea. Cox proportional hazard models were used to estimate hazard ratios for major CVD event (coronary artery disease, heart failure, stroke or transient ischaemic attack) development and all-cause mortality by second-line anti-diabetes medication type. Age, sex, duration of MET monotherapy, calendar year and comorbid conditions were adjusted as potential confounders.

RESULTS

The observed numbers of CVD events (total observed person-time) were 485 (18 778 person-years) for MET + SU, 744 (40 374 person-years) for MET + DPP4i and 60 (3014 person-years) for MET + TZD users. Compared with MET + SU users, the fully adjusted hazard ratios for CVD events were 0.79 [95% confidence interval (CI): 0.71-0.89] for MET + DPP4i users and 0.85 (95% CI: 0.65-1.11) for MET + TZD users. The corresponding hazard ratios for all-cause mortality were 0.84 (95% CI: 0.66-1.07) for MET + DPP4i users and 0.67 (95% CI: 0.35-1.28) for MET + TZD users.

CONCLUSION

Analysis of Korea National Health Insurance database showed that MET + DPP4i treatment for diabetes had a lower CVD risk than MET + SU treatment.

Authors+Show Affiliations

Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, Korea. Cardiovascular and Metabolic Disease Etiology Research Center, Ajou University School of Medicine, Suwon, Korea.Statistics and Actuarial Science, Soongsil University, Seoul, Korea.Department of Public Health, Yonsei University Graduate School, Seoul, Korea. Cardiovascular and Metabolic Disease Etiology Research Center, Yonsei University College of Medicine, Seoul, Korea.Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, Korea. Cardiovascular and Metabolic Disease Etiology Research Center, Ajou University School of Medicine, Suwon, Korea.Cardiovascular and Metabolic Disease Etiology Research Center, Yonsei University College of Medicine, Seoul, Korea. Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea.

Pub Type(s)

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

Language

eng

PubMed ID

28523719

Citation

Ha, K H., et al. "Cardiovascular Events Associated With Second-line Anti-diabetes Treatments: Analysis of Real-world Korean Data." Diabetic Medicine : a Journal of the British Diabetic Association, vol. 34, no. 9, 2017, pp. 1235-1243.
Ha KH, Kim B, Choi H, et al. Cardiovascular events associated with second-line anti-diabetes treatments: analysis of real-world Korean data. Diabet Med. 2017;34(9):1235-1243.
Ha, K. H., Kim, B., Choi, H., Kim, D. J., & Kim, H. C. (2017). Cardiovascular events associated with second-line anti-diabetes treatments: analysis of real-world Korean data. Diabetic Medicine : a Journal of the British Diabetic Association, 34(9), 1235-1243. https://doi.org/10.1111/dme.13384
Ha KH, et al. Cardiovascular Events Associated With Second-line Anti-diabetes Treatments: Analysis of Real-world Korean Data. Diabet Med. 2017;34(9):1235-1243. PubMed PMID: 28523719.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cardiovascular events associated with second-line anti-diabetes treatments: analysis of real-world Korean data. AU - Ha,K H, AU - Kim,B, AU - Choi,H, AU - Kim,D J, AU - Kim,H C, Y1 - 2017/06/05/ PY - 2017/05/15/accepted PY - 2017/5/20/pubmed PY - 2018/5/22/medline PY - 2017/5/20/entrez SP - 1235 EP - 1243 JF - Diabetic medicine : a journal of the British Diabetic Association JO - Diabet Med VL - 34 IS - 9 N2 - AIM: To compare the risks of cardiovascular disease (CVD) and all-cause mortality associated with sulfonylurea (SU), dipeptidyl peptidase-4 inhibitor (DPP4i) and thiazolidinedione (TZD) as add-on medications to metformin (MET) therapy in people with Type 2 diabetes. METHODS: We identified 40 263 individuals who used SU (n = 11 582), DPP4i (n = 26 623) or TZD (n = 2058) in addition to MET between January 2013 and June 2015 from the database of the Korean National Health Insurance, the single-payer healthcare system in South Korea. Cox proportional hazard models were used to estimate hazard ratios for major CVD event (coronary artery disease, heart failure, stroke or transient ischaemic attack) development and all-cause mortality by second-line anti-diabetes medication type. Age, sex, duration of MET monotherapy, calendar year and comorbid conditions were adjusted as potential confounders. RESULTS: The observed numbers of CVD events (total observed person-time) were 485 (18 778 person-years) for MET + SU, 744 (40 374 person-years) for MET + DPP4i and 60 (3014 person-years) for MET + TZD users. Compared with MET + SU users, the fully adjusted hazard ratios for CVD events were 0.79 [95% confidence interval (CI): 0.71-0.89] for MET + DPP4i users and 0.85 (95% CI: 0.65-1.11) for MET + TZD users. The corresponding hazard ratios for all-cause mortality were 0.84 (95% CI: 0.66-1.07) for MET + DPP4i users and 0.67 (95% CI: 0.35-1.28) for MET + TZD users. CONCLUSION: Analysis of Korea National Health Insurance database showed that MET + DPP4i treatment for diabetes had a lower CVD risk than MET + SU treatment. SN - 1464-5491 UR - https://www.unboundmedicine.com/medline/citation/28523719/Cardiovascular_events_associated_with_second_line_anti_diabetes_treatments:_analysis_of_real_world_Korean_data_ L2 - https://doi.org/10.1111/dme.13384 DB - PRIME DP - Unbound Medicine ER -