Chin Hyouk-Jun, Nam Jin Hyun, Lee Eui-Kyung, Shin Ju-Young
School of Pharmacy, Sungkyunkwan University, Suwon, South Korea.
Medicine (Baltimore). 2017 Jun;96(25):e7213. doi: 10.1097/MD.0000000000007213.
Concerns about the cardiovascular safety of dipeptidyl peptidase-4 (DPP-4) inhibitors persist. This study sought to determine whether there is a differential risk of hospitalization for cardiovascular diseases (CVDs) between DPP-4 inhibitors and glimepiride.We conducted this retrospective cohort study by using the Korean National Health Insurance Service database from December 1, 2008, to December 31, 2013. The study subjects were new users of DPP-4 inhibitors or glimepiride for type 2 diabetes. Outcome was defined as hospitalization for CVDs, including angina pectoris, myocardial infarction, transient cerebral ischemic attack, heart failure, or cerebrovascular disease or any procedure involving coronary artery bypass grafting or percutaneous coronary intervention. We used a Cox proportional hazard model to estimate the adjusted hazard ratios (aHRs) and their 95% confidence intervals (CIs), to assess the risk of CVDs associated with the use of DPP-4 inhibitors compared with glimepiride.The cohort consisted of 1,045,975 patients, with 6504 in the DPP-4 inhibitors group and 13,447 in the glimepiride group. No significant increased risk of total CVDs was found (aHR, 0.87; 95% CI, 0.75-1.01) in the DPP-4 inhibitors versus glimepiride group. A decreased risk of hospitalization for CVDs was found among patients with a history of visit for CVDs (aHR, 0.73; 95% CI, 0.56-0.97) or with >2.5 years' duration of type 2 diabetes (aHR, 0.77; 95% CI, 0.66-0.91) in the DPP-4 inhibitors versus glimepiride group.DPP-4 inhibitors did not increase cardiovascular risk compared with glimepiride regardless of CVD history and diabetes duration.
对二肽基肽酶 -4（DPP -4）抑制剂心血管安全性的担忧依然存在。本研究旨在确定DPP -4抑制剂与格列美脲相比，心血管疾病（CVD）住院风险是否存在差异。我们利用韩国国民健康保险服务数据库，于2008年12月1日至2013年12月31日进行了这项回顾性队列研究。研究对象为2型糖尿病患者中DPP -4抑制剂或格列美脲的新使用者。结局定义为CVD住院，包括心绞痛、心肌梗死、短暂性脑缺血发作、心力衰竭、脑血管疾病或任何涉及冠状动脉搭桥术或经皮冠状动脉介入治疗的手术。我们使用Cox比例风险模型来估计调整后的风险比（aHRs）及其95%置信区间（CIs），以评估与使用格列美脲相比，DPP -4抑制剂使用相关的CVD风险。该队列由1,045,975名患者组成，其中DPP -4抑制剂组有6504名患者，格列美脲组有13,447名患者。与格列美脲组相比，DPP -4抑制剂组未发现总CVD风险显著增加（aHR，0.87；95% CI，0.75 - 1.01）。在有CVD就诊史（aHR，0.73；95% CI，0.56 - 0.97）或2型糖尿病病程超过2.5年（aHR，0.77；95% CI，0.66 - 0.91）的患者中，与格列美脲组相比，DPP -4抑制剂组CVD住院风险降低。无论CVD病史和糖尿病病程如何，DPP -4抑制剂与格列美脲相比均未增加心血管风险。
