Kim Young-Gun, Yoon Dukyong, Park Sooyoung, Han Seung Jin, Kim Dae Jung, Lee Kwan-Woo, Park Rae Woong, Kim Hae Jin
From the Department of Biomedical Informatics (Y.-G.K., D.Y., S.P., R.W.P.), Department of Endocrinology and Metabolism (S.J.H., D.J.K., K.-W. L., H.J.K.), and Department of Biomedical Sciences (R.W.P.), Ajou University School of Medicine, Suwon, South Korea; and Department of Statistics, Ewha Womans University, Seoul, South Korea (S.P.).
Circ Heart Fail. 2017 Sep;10(9). doi: 10.1161/CIRCHEARTFAILURE.117.003957.
The association between dipeptidyl-peptidase IV inhibitors (DPP-4i) and heart failure (HF) remains unclear. In 1 randomized controlled trial and some observational studies, DPP-4i reportedly increased the risk of HF, but 2 other randomized controlled trials and observational studies have shown no such risk. Here, we evaluated the risk of HF and cardiovascular outcomes of DPP-4i compared with sulfonylureas.
A population-based retrospective cohort study was conducted using the Korean Health Insurance Review and Assessment Service database from January 1, 2009, to December 31, 2015. Incident users of sulfonylurea and DPP-4i who were not prescribed the comparator drug in the year before treatment initiation were included. DPP-4i-treated and sulfonylurea-treated patients were matched on propensity score, calculated with >40 variables. The risk of hospitalization for HF was evaluated with a Cox proportional hazards model in 255 691 matched pairs. Analyses were conducted in the total patient population and in both strata divided by the presence of cardiovascular disease during the baseline period. The hazard ratios (HRs) of hospitalization for HF for DPP-4i-treated patients were 0.78 (95% confidence interval [CI], 0.67-0.86) in all of the patients, 0.77 (95% CI, 0.68-0.79) in patients with baseline cardiovascular disease, and 0.71 (95% CI, 0.56-0.90) in patients without baseline cardiovascular disease compared with HRs for sulfonylurea-treated patients. Sitagliptin and linagliptin showed statistically lower risk for hospitalization for HF (HR, 0.76; 95% CI, 0.67-0.86 for sitagliptin-prescribed patients; HR, 0.74; 95% CI, 0.59-0.92 for linagliptin-prescribed patients) than for sulfonylurea. The HRs for hospitalization for myocardial infarction and stroke with the use of a DPP-4i versus sulfonylurea were HR, 0.76 (95% CI, 0.67-0.87) and HR, 0.63 (95% CI, 0.60-0.67), respectively.
Our findings suggest that DPP-4i use did not increase the risk of HF compared with sulfonylurea. In addition, the risks for cardiovascular outcomes were not elevated in DPP-4i-treated patients compared with sulfonylurea-treated patients.
二肽基肽酶IV抑制剂（DPP - 4i）与心力衰竭（HF）之间的关联仍不明确。在1项随机对照试验和一些观察性研究中，据报道DPP - 4i增加了HF风险，但另外2项随机对照试验和观察性研究并未显示出此类风险。在此，我们评估了与磺脲类药物相比，DPP - 4i导致HF及心血管结局的风险。
利用韩国健康保险审查与评估服务数据库，于2009年1月1日至2015年12月31日进行了一项基于人群的回顾性队列研究。纳入在开始治疗前一年未使用对照药物的磺脲类药物和DPP - 4i的新使用者。根据倾向评分对接受DPP - 4i治疗和磺脲类药物治疗的患者进行匹配，该评分由40多个变量计算得出。采用Cox比例风险模型在255 691对匹配病例中评估HF住院风险。在全部患者人群以及根据基线期心血管疾病的有无划分的两个亚组中进行分析。与磺脲类药物治疗的患者相比，接受DPP - 4i治疗的患者发生HF住院的风险比（HR）在所有患者中为0.78（95%置信区间[CI]，0.67 - 0.86），在有基线心血管疾病的患者中为0.77（95% CI，0.68 - 0.79），在无基线心血管疾病的患者中为0.71（95% CI，0.56 - 0.90）。与磺脲类药物相比，使用西他列汀和利格列汀的患者发生HF住院的风险在统计学上更低（使用西他列汀的患者HR为0.76；95% CI，0.67 - 0.86；使用利格列汀的患者HR为0.74；95% CI，0.59 - 0.92）。使用DPP - 4i与磺脲类药物相比，心肌梗死和中风住院的HR分别为0.76（95% CI，0.67 - 0.87）和0.63（95% CI，0.60 - 0.67）。
我们的研究结果表明，与磺脲类药物相比，使用DPP - 4i不会增加HF风险。此外，与磺脲类药物治疗的患者相比，接受DPP - 4i治疗的患者发生心血管结局的风险并未升高。
