Risks of cardiovascular diseases associated with dipeptidyl peptidase-4 inhibitors and other antidiabetic drugs in patients with type 2 diabetes: a nation-wide longitudinal study

Ou, Horng Yih; Chang, Kai Cheng; Li, Chung‐Yi; Wu, Jin Shang

doi:10.1186/s12933-016-0350-4

Cited by 63 publications

(59 citation statements)

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“…With regard to cardiovascular risk associated with DPP‐4Is relative to α‐GIs in Asian patients, Ou et al reported that there were no major differences in the risk of MI, HF, and stroke between DPP‐4Is and α‐GIs. In general, our results support these findings and contribute to providing more robust evidence on the widespread use of α‐GIs in Asia due to its pharmacological action and lower cardiovascular risk .…”

Section: Discussionmentioning

confidence: 99%

“…Nonetheless, the results of sensitivity analysis, in which clinical outcome with mortality was used as a definition of censoring, were consistent with primary analysis. The risk of HF was also examined by comparison with results from previous studies . Lastly, we only focused on DPP‐4Is as monotherapy and could not investigate the effect of individual DPP‐4Is or combination therapy with other drugs.…”

Section: Discussionmentioning

confidence: 99%

“…Typically, clinical trials cannot consider situations in clinical practice, such as changes in antidiabetic drugs, and the number of enrolled patients is limited. There are several observational studies assessing risks to Asian patients . However, there is no nationwide study in Japan.…”

Section: Introductionmentioning

confidence: 99%

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Cardiovascular risks associated with dipeptidyl peptidase‐4 inhibitors monotherapy compared with other antidiabetes drugs in the Japanese population: A nationwide cohort study

Komamine

Kajiyama

Ishiguro

et al. 2019

Pharmacoepidemiology and Drug

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Purpose We evaluated the cardiovascular risk associated with dipeptidyl peptidase‐4 inhibitors (DPP‐4Is) as monotherapy compared with other antidiabetic drugs in Japan. Methods We conducted a nationwide cohort study involving 2 716 000 diabetes patients in Japan. New users of any antidiabetic drug as monotherapy between 1 April 2010 and 31 October 2014 were identified. Occurrences of myocardial infarction (MI), heart failure (HF), and stroke requiring hospitalization associated with DPP‐4Is were compared with those associated with biguanides (BGs), sulfonylureas (SUs), or α‐glucosidase inhibitors (α‐GIs). Adjusted hazard ratios (aHRs) for these outcomes were estimated by Cox proportional hazards model. Propensity score standardization was used to control for confounding. Results We identified 1 105 103 patients using DPP‐4Is, 278 280 patients using BGs, 273 449 patients using SUs, and 217 026 patients using α‐GIs. The risks of MI and HF for DPP‐4I users were significantly higher than those for BG users (MI: aHR, 1.48 [95%CI, 1.20‐1.82], HF: aHR, 1.46 [95%CI, 1.31‐1.62]), while significantly lower than those for SU users (MI: aHR, 0.84 [95%CI, 0.72‐0.98], HF: aHR, 0.86 [95%CI, 0.81‐0.92]). The risk of MI for DPP‐4I users was similar to that for α‐GI users, while the risk of HF for DPP‐4I users was slightly higher than for α‐GI users (MI: aHR, 0.98 [95%CI, 0.82‐1.17], HF: aHR, 1.12[95%CI, 1.04‐1.21]). Conclusions Risk of MI and HF requiring hospitalization associated with DPP‐4Is as monotherapy was significantly higher than BGs, significantly lower than SUs, and similar to α‐GIs.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Cardiovascular risks associated with dipeptidyl peptidase‐4 inhibitors monotherapy compared with other antidiabetes drugs in the Japanese population: A nationwide cohort study

Komamine

Kajiyama

Ishiguro

et al. 2019

Pharmacoepidemiology and Drug

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“…Previous studies revealed that both DPP-4i and metformin users had a significantly lower risk for composite cardiovascular diseases [18]. The combination therapy of DPP4i with conventional OHA led to an improvement in passive left ventricular compliance [20].…”

Section: Discussionmentioning

confidence: 99%

The impact of DPP-4 inhibitors on long-term survival among diabetic patients after first acute myocardial infarction

Wang

Lin

Tang

et al. 2017

Cardiovasc Diabetol

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BackgroundPrevious studies regarding the cardioprotective effects of dipeptidyl peptidase 4 (DPP-4) inhibitors have not provided sufficient evidence of a relationship between DPP-4 inhibition and actual cardiovascular outcomes. This study aimed to evaluate the impact of DPP-4 inhibitors on the survival of diabetic patients after first acute myocardial infarction (AMI).MethodsThis was a nationwide, propensity score-matched, case–control study of 186,112 first AMI patients, 72,924 of whom had diabetes. A propensity score, one-to-one matching technique was used to match 2672 controls to 2672 patients in the DPP-4 inhibitor group for analysis. Controls were matched based on gender, age, and a history of hypertension, dyslipidemia, diabetes, peripheral vascular disease, heart failure, cerebrovascular accident, end-stage renal disease, chronic obstructive pulmonary disease, and percutaneous coronary intervention.ResultsDPP-4 inhibitors improve the overall 3-year survival rate (log rank P < 0.0001), whether male or female. Cox proportional hazard regression showed DPP-4 inhibitor is beneficial in diabetes patients after AMI (HR = 0.86; 95% CI 0.78–0.95), especially in those patients with hypertension (HR = 0.87; 95% CI 0.78–0.97; P = 0.0103) and cerebrovascular disease (HR = 0.83; 95% CI 0.72–0.97; P = 0.018), but without dyslipidemia (HR = 0.78; 95% CI 0.67–0.92; P = 0.0029), without peripheral vascular disease (HR = 0.86; 95% CI 0.78–0.96; P = 0.0047), without heart failure (HR = 0.84; 95% CI 0.73–0.96; P = 0.0106), without end stage renal disease (HR = 0.86; 95% CI 0.77–0.95; P = 0.0035), and without chronic obstructive pulmonary disease (HR = 0.87; 95% CI 0.78–0.97; P = 0.0096).ConclusionsDPP-4 inhibitor therapy improved long-term survival in diabetic patients after first AMI, regardless of gender.

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“…60,61 In randomized trial of 5380 patients with T2DM and recent acute coronary syndrome in the last 15-90 days, alogliptin was non inferior to placebo with regards to the combined primary outcome of cardiovascular death, nonfatal MI or non-fatal stroke after a median follow up of 18 months. 62 A post hoc analysis showed that alogliptin had no effect on heart failure outcomes, including a composite of cardiovascular death and heart failure hospitalization. 63 In the trial to evaluate cardiovascular outcome after treatment with sitagliptin (TECOS) study, which randomized 14,671 patients with T2DM, sitagliptin was non-inferior to placebo for the primary composite outcome of cardiovascular death, non-fatal MI, non-fatal stroke or hospitalization for unstable angina with no difference in hospitalization rates for heart failure.…”

Section: Dipeptidyl Peptidase-4 Inhibitors (Dpp-4 Inhibitors)mentioning

confidence: 99%

Cardiovascular safety of oral antidiabetic therapy in type 2 diabetes mellitus- review article

et al. 2017

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Cardiovascular disease is the leading cause of morbidity and mortality among patients with type 2 diabetes mellitus (DM). There is twofold increased risk of cardiovascular (CV) mortality among diabetic patients as compared with nondiabetic patients. The glycemic efficacy of anti-diabetic drugs does not necessarily provide cardiovascular safety. Since 2008, US Food and Drug Administration has recommended that new drugs for type 2 DM should undergo clinical trials to demonstrate cardiovascular safety in addition to glycemic benefit. In 2012, European medicine agencies issued a similar recommendation. In this review, we have tried to examine the cardiovascular safety of oral antidiabetic agents in major published trials. Metformin remains the initial drug of choice in type2 DM till date. The sulfonylureas, one of oldest oral anti-diabetic drugs, have adverse cardiovascular events and are gradually being out classed by other second line drugs. The glitazones have been found to have adverse outcome in heart failure. The incretin based drugs have been found to have cardiovascular safety in various trials in recent past and their performances have been reassuring. There is lack of enough cardiovascular outcome data for meglitinides and glucosidase inhibitors. Various current trials have found sodium glucose cotransporter-2 inhibitors to have a potential for cardiovascular benefit. Careful selection of drug therapy with special attention for cardiovascular risk is important in selection and optimization of diabetic therapy.

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Risks of cardiovascular diseases associated with dipeptidyl peptidase-4 inhibitors and other antidiabetic drugs in patients with type 2 diabetes: a nation-wide longitudinal study

Cited by 63 publications

References 50 publications

Cardiovascular risks associated with dipeptidyl peptidase‐4 inhibitors monotherapy compared with other antidiabetes drugs in the Japanese population: A nationwide cohort study

Cardiovascular risks associated with dipeptidyl peptidase‐4 inhibitors monotherapy compared with other antidiabetes drugs in the Japanese population: A nationwide cohort study

The impact of DPP-4 inhibitors on long-term survival among diabetic patients after first acute myocardial infarction

Cardiovascular safety of oral antidiabetic therapy in type 2 diabetes mellitus- review article

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