针对胰高血糖素样肽1途径的抗糖尿病药物与糖尿病患者心力衰竭事件的关联。
Association of antidiabetic medications targeting the glucagon-like peptide 1 pathway and heart failure events in patients with diabetes.
作者信息
Velez Mauricio, Peterson Edward L, Wells Karen, Swadia Tanmay, Sabbah Hani N, Williams L Keoki, Lanfear David E
机构信息
Department of Internal Medicine, Henry Ford Health System, Detroit, Michigan.
Department of Public Health Sciences, Henry Ford Health System, Detroit, Michigan.
出版信息
J Card Fail. 2015 Jan;21(1):2-8. doi: 10.1016/j.cardfail.2014.10.012. Epub 2014 Oct 28.
BACKGROUND
Glucagon-like peptide-1 (GLP-1) agonists and dipeptidyl peptidase 4 (DPP-4) inhibitors (GLP-1 agents) may be protective in heart failure (HF). We set out to determine whether GLP-1 agent use is associated with HF risk in diabetics.
METHODS AND RESULTS
In this retrospective cohort study of members of a large health system, we identified >19,000 adult diabetics from January 1, 2000, to July 1, 2012. GLP-1 agent users were matched 1:2 to control subjects with the use of propensity matching based on age, race, sex, coronary disease, HF, diabetes duration, and number of antidiabetic medications. The association of GLP-1 agents with time to HF hospitalization was tested with multivariable Cox regression. All-cause hospitalization and mortality were secondary end points. We identified 1,426 users of GLP-1 agents and 2,798 control subjects. Both were similar except for angiotensin-converting enzyme inhibitors/angiotensin receptor blocker use, number of antidiabetic medications, and age. There were 199 hospitalizations, of which 128 were for HF, and 114 deaths. GLP-1 agents were associated with reduced risk of HF hospitalization (adjusted hazard ratio [aHR] 0.51, 95% confidence interval [CI] 0.34-0.77; P = .002), all-cause hospitalization (aHR 0.54, 95% CI 0.38-0.74; P = .001), and death (aHR 0.31, 95% CI 0.18-0.53; P = .001).
CONCLUSIONS
GLP-1 agents may reduce the risk of HF events in diabetics.
背景
胰高血糖素样肽-1（GLP-1）激动剂和二肽基肽酶4（DPP-4）抑制剂（GLP-1类药物）可能对心力衰竭（HF）具有保护作用。我们旨在确定使用GLP-1类药物是否与糖尿病患者发生HF的风险相关。
方法与结果
在这项针对一个大型医疗系统成员的回顾性队列研究中，我们识别出了从2000年1月1日至2012年7月1日期间的19000多名成年糖尿病患者。基于年龄、种族、性别、冠心病、HF、糖尿病病程和抗糖尿病药物数量，使用倾向匹配法将GLP-1类药物使用者与对照受试者按1:2进行匹配。采用多变量Cox回归检验GLP-1类药物与HF住院时间的关联。全因住院和死亡率为次要终点。我们识别出1426名GLP-1类药物使用者和2798名对照受试者。除血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂的使用、抗糖尿病药物数量和年龄外，两者相似。共有199次住院，其中128次为HF住院，114例死亡。GLP-1类药物与HF住院风险降低相关（校正风险比[aHR]0.51，95%置信区间[CI]0.34 - 0.77；P = .002）、全因住院风险降低相关（aHR 0.54，95% CI 0.38 - 0.74；P = .001）以及死亡风险降低相关（aHR 0.31，95% CI 0.18 - 0.53；P = .001）。
结论
GLP-1类药物可能降低糖尿病患者发生HF事件的风险。
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