Department of Medicine, University of Padova, Via Giustiniani, 2, 35128 Padova, Italy.
Department of Medicine, University of Padova, Via Giustiniani, 2, 35128 Padova, Italy
Eur Heart J. 2015 Sep 21;36(36):2454-62. doi: 10.1093/eurheartj/ehv301. Epub 2015 Jun 25.
Oral glucose-lowering medications are associated with excess risk of heart failure (HF). Given the absence of comparative data among drug classes, we performed a retrospective study in 32 Health Services of 16 Italian regions accounting for a population of 18 million individuals, to assess the association between HF risk and use of sulphonylureas, DPP-4i, and glitazones.
We extracted data on patients with type 2 diabetes who initiated treatment with DPP-4i, thiazolidinediones, or sulphonylureas alone or in combination with metformin during an accrual time of 2 years. The endpoint was hospitalization for HF (HHF) occurring after the first 6 months of therapy, and the observation was extended for up to 4 years. A total of 127 555 patients were included, of whom 14.3% were on DPP-4i, 72.5% on sulphonylurea, 13.2% on thiazolidinediones, with average 70.7% being on metformin as combination therapy. Patients in the three groups differed significantly for baseline characteristics: age, sex, Charlson index, concurrent medications, and previous cardiovascular events. During an average 2.6-year follow-up, after adjusting for measured confounders, use of DPP-4i was associated with a reduced risk of HHF compared with sulphonylureas [hazard ratio (HR) 0.78; 95% confidence interval (CI) 0.62-0.97; P = 0.026]. After propensity matching, the analysis was restricted to 39 465 patients, and the use of DPP-4i was still associated with a lower risk of HHF (HR 0.70; 95% CI 0.52-0.94; P = 0.018).
In a very large observational study, the use of DPP-4i was associated with a reduced risk of HHF when compared with sulphonylureas.
口服降糖药与心力衰竭（HF）风险增加相关。鉴于药物类别之间缺乏比较数据，我们对意大利 16 个地区的 32 个卫生服务机构的 1800 万人口进行了一项回顾性研究，以评估 HF 风险与使用磺酰脲类、DPP-4i 和噻唑烷二酮类之间的关系。
我们提取了在 2 年累积时间内单独或联合使用二甲双胍开始接受 DPP-4i、噻唑烷二酮或磺酰脲类治疗的 2 型糖尿病患者的数据。终点是治疗后 6 个月内发生的 HF 住院（HHF），观察期延长至 4 年。共纳入 127555 例患者，其中 14.3%使用 DPP-4i，72.5%使用磺酰脲类，13.2%使用噻唑烷二酮类，平均 70.7%作为联合治疗使用二甲双胍。三组患者的基线特征差异显著：年龄、性别、Charlson 指数、同时使用的药物和既往心血管事件。在平均 2.6 年的随访中，在校正了测量的混杂因素后，与磺酰脲类药物相比，使用 DPP-4i 与 HHF 风险降低相关[风险比（HR）0.78；95%置信区间（CI）0.62-0.97；P=0.026]。在倾向匹配后，分析仅限于 39465 例患者，使用 DPP-4i 仍与 HHF 风险降低相关（HR 0.70；95%CI 0.52-0.94；P=0.018）。
在一项非常大型的观察性研究中，与磺酰脲类药物相比，使用 DPP-4i 与 HHF 风险降低相关。
