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Dipeptidyl peptidase-4 inhibitors and cardiovascular risks in patients with pre-existing heart failure
  1. Shuo-Ming Ou1,2,
  2. Hung-Ta Chen2,3,
  3. Shu-Chen Kuo2,4,5,
  4. Tzeng-Ji Chen6,
  5. Chia-Jen Shih2,7,
  6. Yung-Tai Chen2,8
  1. 1Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
  2. 2School of Medicine, National Yang-Ming University, Taipei, Taiwan
  3. 3Division of Endocrinology and Metabolism, Department of Medicine, Taipei City Hospital, Heping Fuyou Branch, Taipei, Taiwan
  4. 4Division of Infectious Diseases, Taipei Veterans General Hospital, Taipei, Taiwan
  5. 5National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Miaoli County, Taiwan
  6. 6Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
  7. 7Department of Medicine, Taipei Veterans General Hospital, Yuanshan Branch, Yilan, Taiwan
  8. 8Division of Nephrology, Department of Medicine, Taipei City Hospital, Heping Fuyou Branch, Taipei, Taiwan
  1. Correspondence to Dr Yung-Tai Chen, Department of Nephrology, Taipei City Hospital Heping Fuyou Branch, Taipei 112, Taiwan; ytchen0117{at}gmail.com Dr Chia-Jen Shih, Deran Clinic, Yilan 260, Taiwan; drcjshih{at}gmail.com

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.

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