Do Incretin-Based Drugs Increase Risk of Heart Failure?

Sep 14, 2016
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Authors:
Filion KB, Azoulay L, Platt RW, et al., on behalf of the CNODES Investigators.
Citation:
A Multicenter Observational Study of Incretin-Based Drugs and Heart Failure. N Engl J Med 2016;374:1145-1154.
Summary By:
Prashant Vaishnava, MD, FACC

Study Questions:

Is the use of incretin-based drugs, as compared with oral antidiabetic drug combinations, associated with an increased risk of heart failure?

Methods:

This was a retrospective analysis of multiple cohorts of patients with diabetes. The authors used health care data from four Canadian provinces, the United States, and the United Kingdom. A nested case-control analysis was used to determine cohort-specific hazard ratios for hospitalization due to heart failure among patients receiving incretin-based drugs, as compared with those receiving oral antidiabetic drug combinations.

Results:

The cohorts included a total of 1,499,650 patients, with 29,741 patients hospitalized for heart failure during 3,242,291 person-years of follow-up. The rate of hospitalization for heart failure did not increase with the use of incretin-based drugs as compared with oral antidiabetic drug combinations among patients with a history of heart failure (hazard ratio [HR], 0.86; 95% confidence interval [CI], 0.62-1.19) or among those without a history of heart failure (HR, 0.82; 95% CI, 0.67-1.00).

Conclusions:

The use of incretin-based drugs, as compared with combinations of oral antidiabetic drugs, was not associated with an increased risk of hospitalization for heart failure.

Perspective:

As the authors point out, to date, three randomized, placebo-controlled trials of dipeptidyl peptidase 4 (DPP-4) inhibitors (SAVOR-TIMI 53, EXAMINE, and TECOS) have shown conflicting findings regarding the risk of hospitalization for heart failure. This retrospective analysis of 1.5 million patients is an attempt to settle this controversy with the unambiguous observation that incretin-based drugs, when compared with combinations of oral antidiabetic drugs, are not associated with an increased risk of hospitalization for heart failure.

Keywords: Diabetes Mellitus, Dipeptidyl Peptidase 4, Drug Combinations, Heart Failure, Hospitalization, Hypoglycemic Agents, Incretins, Metabolic Syndrome, Risk Assessment, Secondary Prevention


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