DPP-4 Inhibitors and Risk for Hospitalization for Heart Failure | Journal Scan

Study Questions:

What is the effect of immediate delivery versus expectant monitoring on maternal and neonatal outcomes for women with hypertensive disorders between 34 and 37 weeks’ gestation?

Methods:

This was a retrospective study of data from the Nationwide OsMed Health-DB Database. The authors included all patients with type 2 diabetes mellitus (T2D) who were prescribed for the first time and at least once a DPP-4 inhibitor (DPP-4i), a sulfonylurea, or a glitazone. The endpoint was defined as a hospital discharge event with a primary diagnosis of heart failure (HF). The endpoint was met only when HF was the primary diagnosis (e.g., not when it was a concomitant diagnosis as with a primary diagnosis of acute kidney disease or acute respiratory failure).

Results:

The analytic sample included 127,555 patients. During the observation period, 14.3% were treated with a DPP-4i; 72.5%, sulfonylurea; and 13.2%, glitazone. Overall, 70.7% of the patients were co-treated with metformin. During a mean follow-up of 2.6 years, 1,776 hospital discharge events were recorded, occurring in 1,319 patients (equal to an average of 1.35 episodes/patient). In adjusted analyses, use of DPP-4i was associated with a reduced risk of hospitalization for HF compared with sulfonylureas (hazard ratio [HR], 0.78; 95% confidence interval [CI], 0.62-0.97; p = 0.026). Compared to patients treated with a glitazone, those treated with a DPP-4i had a nonsignificant, but lower risk for the primary endpoint (HR, 0.89; 95% CI, 0.74-1.06; p = 0.188). Even after propensity matching, the risk of hospitalization for HF remained significantly lower in patients treated with a DPP-4i (HR, 0.70; 95% CI, 0.52-0.94; p = 0.018) than that in patients treated with a sulfonylurea.

Conclusions:

The use of DPP-4i is associated with a reduced risk of hospitalization for HF when compared with sulfonylureas.

Perspective:

This is a valuable study that may provide reassurance about the use of DPP-4i for the management of T2D. Some data have suggested an increased risk for hospitalization for HF ascribed to these oral medications. The results from this very large retrospective analysis counter to these data. As the authors write, ‘While waiting for the forthcoming phase IV randomized comparator-controlled trials on cardiovascular outcomes of DPP-4i, this reassuring finding may provide a basis for guiding the clinical care of patients with T2D.’ It should also be noted that the authors did not demonstrate an excess risk for hospitalization for HF among patients treated with glitazones; as the authors posit, perhaps this reflects the caution with which clinicians prescribe this class of medications (avoiding their use in patients at risk for HF).

Clinical Topics: Diabetes and Cardiometabolic Disease, Heart Failure and Cardiomyopathies, Prevention, Acute Heart Failure

Keywords: Diabetes Mellitus, Type 2, Dipeptidyl-Peptidase IV Inhibitors, Glucose, Heart Failure, Hypoglycemic Agents, Metabolic Syndrome X, Metformin, Registries, Retrospective Studies, Risk, Secondary Prevention, Sulfonylurea Compounds, Thiazolidinediones


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