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Dipeptidyl peptidase-4 inhibitor decreases the risk of atrial fibrillation in patients with type 2 diabetes: a nationwide cohort study in Taiwan.
Cardiovasc Diabetol. 2017 Dec 19; 16(1):159.CD

Abstract

BACKGROUND

Whether dipeptidyl peptidase-4 inhibitor (DPP4i) is associated with a lower risk of new-onset atrial fibrillation (AF) in patients with diabetes remains unclear. This study aimed to evaluate the risk of AF associated with use of DPP4i among a longitudinal cohort of patients with diabetes.

METHODS

Over a 3-year period, 480,000 patients with diabetes were analyzed utilizing Taiwan's National Health Insurance Research Database and 90,880 patients taking metformin as first-line therapy were enrolled. Patients were further divided into two groups: (1) DPP4i users: those taking DPP4i and (2) non-DPP4i users: those prescribed other hypoglycemic agents (HAs) as second-line drug. Study end point was defined by diagnosis of AF, addition of any third-line HA, or the end of the study period (December 31, 2013), whichever came first.

RESULTS

A total of 16,017 DPP4i users and 74,863 non-DPP4i users were eligible for the study. For the DPP4i group, most patients were prescribed sitagliptin (n = 12,180; 76%). Among the non-DPP4i group, most patients took sulfonylurea (n = 60,606; 81%) as their second-line medication. DPP4i users were associated with a lower risk of new-onset AF compared with non-DPP4i users after propensity-score weighting (hazard ratio 0.65; P < 0.0001). Subgroup analysis showed that DPP4i user were associated with a lower risk of new-onset AF compared with non-DPP4i users in most subgroups. Multivariate analysis indicated that use of DPP4i was associated with lower risk of new-onset AF and age > 65 years, presence of hypertension, and ischemic heart disease were independent risk factors for new-onset AF.

CONCLUSIONS

Among patients with diabetes prescribed with metformin, the patients with DPP4i as second HA were associated with a lower risk of AF compared with the patients with other drugs as second HAs in real-world practice.

Authors+Show Affiliations

College of Medicine, Chang Gung University, Taoyuan, 33302, Taiwan.College of Medicine, Chang Gung University, Taoyuan, 33302, Taiwan. Department of Cardiology, Chang Gung Memorial Hospital, Linkou, Taoyuan, 33305, Taiwan.College of Medicine, Chang Gung University, Taoyuan, 33302, Taiwan. Department of Cardiology, Chang Gung Memorial Hospital, Linkou, Taoyuan, 33305, Taiwan. Microscopy Core Laboratory, Chang Gung Memorial Hospital, Linkou, Taoyuan, 33305, Taiwan.Department of Public Health, College of Medicine, Chang Gung University, No. 259, Wenhua 1st Rd., Guishan, Taoyuan, 33302, Taiwan. Biostatistics Core Laboratory, Molecular Medicine Research Center, Chang Gung University, Taoyuan, 33302, Taiwan.College of Medicine, Chang Gung University, Taoyuan, 33302, Taiwan. Department of Cardiology, Chang Gung Memorial Hospital, Linkou, Taoyuan, 33305, Taiwan.College of Medicine, Chang Gung University, Taoyuan, 33302, Taiwan. Department of Cardiology, Chang Gung Memorial Hospital, Linkou, Taoyuan, 33305, Taiwan.College of Medicine, Chang Gung University, Taoyuan, 33302, Taiwan. Department of Cardiology, Chang Gung Memorial Hospital, Linkou, Taoyuan, 33305, Taiwan.College of Medicine, Chang Gung University, Taoyuan, 33302, Taiwan. Department of Cardiology, Chang Gung Memorial Hospital, Linkou, Taoyuan, 33305, Taiwan.College of Medicine, Chang Gung University, Taoyuan, 33302, Taiwan. Department of Cardiology, Chang Gung Memorial Hospital, Linkou, Taoyuan, 33305, Taiwan.Department of Public Health, College of Medicine, Chang Gung University, No. 259, Wenhua 1st Rd., Guishan, Taoyuan, 33302, Taiwan. lichu@mail.cgu.edu.tw. Biostatistics Core Laboratory, Molecular Medicine Research Center, Chang Gung University, Taoyuan, 33302, Taiwan. lichu@mail.cgu.edu.tw. Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, Linkou, Taoyuan, 33305, Taiwan. lichu@mail.cgu.edu.tw.

Pub Type(s)

Comparative Study
Journal Article
Observational Study

Language

eng

PubMed ID

29258504

Citation

Chang, Chia-Yu, et al. "Dipeptidyl Peptidase-4 Inhibitor Decreases the Risk of Atrial Fibrillation in Patients With Type 2 Diabetes: a Nationwide Cohort Study in Taiwan." Cardiovascular Diabetology, vol. 16, no. 1, 2017, p. 159.
Chang CY, Yeh YH, Chan YH, et al. Dipeptidyl peptidase-4 inhibitor decreases the risk of atrial fibrillation in patients with type 2 diabetes: a nationwide cohort study in Taiwan. Cardiovasc Diabetol. 2017;16(1):159.
Chang, C. Y., Yeh, Y. H., Chan, Y. H., Liu, J. R., Chang, S. H., Lee, H. F., Wu, L. S., Yen, K. C., Kuo, C. T., & See, L. C. (2017). Dipeptidyl peptidase-4 inhibitor decreases the risk of atrial fibrillation in patients with type 2 diabetes: a nationwide cohort study in Taiwan. Cardiovascular Diabetology, 16(1), 159. https://doi.org/10.1186/s12933-017-0640-5
Chang CY, et al. Dipeptidyl Peptidase-4 Inhibitor Decreases the Risk of Atrial Fibrillation in Patients With Type 2 Diabetes: a Nationwide Cohort Study in Taiwan. Cardiovasc Diabetol. 2017 Dec 19;16(1):159. PubMed PMID: 29258504.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Dipeptidyl peptidase-4 inhibitor decreases the risk of atrial fibrillation in patients with type 2 diabetes: a nationwide cohort study in Taiwan. AU - Chang,Chia-Yu, AU - Yeh,Yung-Hsin, AU - Chan,Yi-Hsin, AU - Liu,Jia-Rou, AU - Chang,Shang-Hung, AU - Lee,Hsin-Fu, AU - Wu,Lung-Sheng, AU - Yen,Kun-Chi, AU - Kuo,Chi-Tai, AU - See,Lai-Chu, Y1 - 2017/12/19/ PY - 2017/09/01/received PY - 2017/12/06/accepted PY - 2017/12/21/entrez PY - 2017/12/21/pubmed PY - 2018/8/1/medline KW - Atrial fibrillation KW - Dipeptidyl peptidase-4 inhibitor KW - Type 2 diabetes mellitus SP - 159 EP - 159 JF - Cardiovascular diabetology JO - Cardiovasc Diabetol VL - 16 IS - 1 N2 - BACKGROUND: Whether dipeptidyl peptidase-4 inhibitor (DPP4i) is associated with a lower risk of new-onset atrial fibrillation (AF) in patients with diabetes remains unclear. This study aimed to evaluate the risk of AF associated with use of DPP4i among a longitudinal cohort of patients with diabetes. METHODS: Over a 3-year period, 480,000 patients with diabetes were analyzed utilizing Taiwan's National Health Insurance Research Database and 90,880 patients taking metformin as first-line therapy were enrolled. Patients were further divided into two groups: (1) DPP4i users: those taking DPP4i and (2) non-DPP4i users: those prescribed other hypoglycemic agents (HAs) as second-line drug. Study end point was defined by diagnosis of AF, addition of any third-line HA, or the end of the study period (December 31, 2013), whichever came first. RESULTS: A total of 16,017 DPP4i users and 74,863 non-DPP4i users were eligible for the study. For the DPP4i group, most patients were prescribed sitagliptin (n = 12,180; 76%). Among the non-DPP4i group, most patients took sulfonylurea (n = 60,606; 81%) as their second-line medication. DPP4i users were associated with a lower risk of new-onset AF compared with non-DPP4i users after propensity-score weighting (hazard ratio 0.65; P < 0.0001). Subgroup analysis showed that DPP4i user were associated with a lower risk of new-onset AF compared with non-DPP4i users in most subgroups. Multivariate analysis indicated that use of DPP4i was associated with lower risk of new-onset AF and age > 65 years, presence of hypertension, and ischemic heart disease were independent risk factors for new-onset AF. CONCLUSIONS: Among patients with diabetes prescribed with metformin, the patients with DPP4i as second HA were associated with a lower risk of AF compared with the patients with other drugs as second HAs in real-world practice. SN - 1475-2840 UR - https://www.unboundmedicine.com/medline/citation/29258504/Dipeptidyl_peptidase_4_inhibitor_decreases_the_risk_of_atrial_fibrillation_in_patients_with_type_2_diabetes:_a_nationwide_cohort_study_in_Taiwan_ L2 - https://cardiab.biomedcentral.com/articles/10.1186/s12933-017-0640-5 DB - PRIME DP - Unbound Medicine ER -