二肽基肽酶-4 抑制剂与磺酰脲类药物联合二甲双胍对 2 型糖尿病患者的心脏保护作用：一项全国性队列研究。
Cardioprotective effects of dipeptidyl peptidase-4 inhibitors versus sulfonylureas in addition to metformin: A nationwide cohort study of patients with type 2 diabetes.
机构信息
Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei City, Taiwan.
Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei City, Taiwan; Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan; Department of Internal Medicine, National Taiwan University Hospital and College of Medicine, Taipei City, Taiwan; School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei City, Taiwan.
出版信息
Diabetes Metab. 2022 May;48(3):101299. doi: 10.1016/j.diabet.2021.101299. Epub 2021 Oct 30.
AIMS
Cardiovascular effects of dipeptidyl peptidase-4 inhibitors (DPP4i) versus sulfonylureas (SU) remain controversial in observational studies. This study aimed to evaluate the influence of DPP4i on major adverse cardiovascular events (MACEs), including acute myocardial infarction, cerebrovascular disease, heart failure, cardiogenic shock, malignant dysrhythmia, and revascularisation.
MATERIALS AND METHODS
We conducted a nationwide cohort study using claims data from the National Health Insurance in Taiwan from 2007 to 2013. We enrolled type 2 diabetes patients who received DPP4i or SU in addition to metformin. DPP4i users were matched to SU users using propensity scores at a ratio of 1:1. The study outcomes were hospitalisation for MACE, heart failure, acute myocardial infarction, cerebrovascular disease, coronary revascularisation, and hypoglycaemia.
RESULTS
There were 37,317 matched pairs of DPP4i and SU users with a mean follow-up of 2.1 years. Compared with SU users, DPP4i users showed a significantly lower risk of hospitalisation for MACE (HR 0.79 [95% CI 0.75-0.82]), heart failure (0.86 [0.79-0.93]), acute myocardial infarction (0.76 [0.68-0.92]), and cerebrovascular disease (0.72 [0.67-0.77]). Both sitagliptin (0.89 [0.85-0.94]) and vildagliptin ([0.77 [0.60-0.99]) showed a significantly lower risk of hospitalisation for MACE, but saxagliptin showed a borderline significantly higher risk of hospitalisation for heart failure (1.59 [1.00-2.55]).
CONCLUSIONS
DPP4i showed better cardioprotective effects than SU, especially among patients receiving sitagliptin or vildagliptin.
目的
在观察性研究中，二肽基肽酶-4 抑制剂（DPP4i）与磺酰脲类药物（SU）对心血管的影响仍存在争议。本研究旨在评估 DPP4i 对主要不良心血管事件（MACE）的影响，包括急性心肌梗死、脑血管疾病、心力衰竭、心源性休克、恶性心律失常和血运重建。
材料与方法
我们使用台湾全民健康保险理赔数据进行了一项全国性队列研究，研究对象为 2007 年至 2013 年间接受 DPP4i 或 SU 联合二甲双胍治疗的 2 型糖尿病患者。DPP4i 使用者与 SU 使用者按倾向评分 1:1 进行匹配。研究结局为 MACE、心力衰竭、急性心肌梗死、脑血管疾病、冠状动脉血运重建和低血糖住院。
结果
共纳入 37317 对 DPP4i 和 SU 使用者，平均随访时间为 2.1 年。与 SU 使用者相比，DPP4i 使用者 MACE（风险比 0.79 [95%置信区间 0.75-0.82]）、心力衰竭（0.86 [0.79-0.93]）、急性心肌梗死（0.76 [0.68-0.92]）和脑血管疾病（0.72 [0.67-0.77]）住院风险显著降低。西他列汀（0.89 [0.85-0.94]）和维格列汀（[0.77 [0.60-0.99]）均显示出显著降低 MACE 住院风险的作用，而沙格列汀则显示出心力衰竭住院风险的临界显著升高（1.59 [1.00-2.55]）。
结论
DPP4i 比 SU 具有更好的心脏保护作用，尤其是在接受西他列汀或维格列汀治疗的患者中。
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