Differential cardiovascular outcomes after dipeptidyl peptidase-4 inhibitor, sulfonylurea, and pioglitazone therapy, all in combination with metformin, for type 2 diabetes: a population-based cohort study.
Differential cardiovascular outcomes after dipeptidyl peptidase-4 inhibitor, sulfonylurea, and pioglitazone therapy, all in combination with metformin, for type 2 diabetes: a population-based cohort study.
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DOI：
10.1371/journal.pone.0124287
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发表时间：
2015
期刊：
影响因子：
3.7
通讯作者：
Park BJ
中科院分区：
文献类型：
--
作者：
Seong JM;Choi NK;Shin JY;Chang Y;Kim YJ;Lee J;Kim JY;Park BJ
在临床实践中，口服降糖药对心血管结局的比较有效性的数据有限。本研究旨在确定二肽基肽酶-4（DPP-4）抑制剂联合二甲双胍与磺酰脲类衍生物联合二甲双胍或吡格列酮联合二甲双胍是否存在心血管疾病（CVD）的差异风险。我们使用韩国国家健康保险索赔数据库对349，476例接受DPP-4抑制剂、磺脲类药物或吡格列酮加二甲双胍治疗2型糖尿病的患者进行了一项队列研究。采用根据倾向评分加权的考克斯比例风险模型估计的风险比（HR）评估总CVD发生率和心肌梗死（MI）、心力衰竭（HF）和缺血性卒中（IS）的个体结局。在随访期间，3，881例患者发生了CVD，包括428例MI，212例HF和1，487例IS。与DPP-4抑制剂+二甲双胍相比，磺酰脲类衍生物+二甲双胍的校正HR和95%置信区间（CI）为：总CVD为1.20（1.09-1.32）; MI为1.14（1.04-1.91）; HF为1.07（0.71-1.62）; IS为1.51（1.28-1.79）。吡格列酮+二甲双胍组总CVD、MI、HF和IS的HR和95% CI分别为0.89（0.81-0.99）、1.05（0.76-1.46）、4.81（3.53-6.56）和0.81（0.67-0.99）。与DPP-4抑制剂加二甲双胍相比，磺脲类药物加二甲双胍治疗与总CVD、MI和IS风险增加相关，而吡格列酮加二甲双胍治疗与总CVD和IS风险降低相关。
Data on the comparative effectiveness of oral antidiabetics on cardiovascular outcomes in a clinical practice setting are limited. This study sought to determine whether a differential risk of cardiovascular disease (CVD) exists for the combination of a dipeptidyl peptidase-4 (DPP-4) inhibitor plus metformin versus a sulfonylurea derivative plus metformin or pioglitazone plus metformin. We conducted a cohort study of 349,476 patients who received treatment with a DPP-4 inhibitor, sulfonylurea, or pioglitazone plus metformin for type 2 diabetes using the Korean national health insurance claims database. The incidence of total CVD and individual outcomes of myocardial infarction (MI), heart failure (HF), and ischemic stroke (IS) were assessed using the hazard ratios (HRs) estimated from a Cox proportional-hazards model weighted for a propensity score. During follow-up, 3,881 patients developed a CVD, including 428 MIs, 212 HFs, and 1,487 ISs. The adjusted HR with 95% confidence interval (CI) for a sulfonylurea derivative plus metformin compared with a DPP-4 inhibitor plus metformin was 1.20 (1.09-1.32) for total CVD; 1.14 (1.04-1.91) for MI; 1.07 (0.71-1.62) for HF; and 1.51 (1.28-1.79) for IS. The HRs with 95% CI for total CVD, MI, HF, and IS for pioglitazone plus metformin were 0.89 (0.81-0.99), 1.05 (0.76-1.46), 4.81 (3.53-6.56), and 0.81 (0.67-0.99), respectively. Compared with a DPP-4 inhibitor plus metformin, treatment with a sulfonylurea drug plus metformin was associated with increased risks of total CVD, MI, and IS, whereas the use of pioglitazone plus metformin was associated with decreased total CVD and IS risks.
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DOI：
10.1111/j.1742-1241.2010.02516.x
发表时间：
2010-11-01
影响因子：
2.6
作者：
Cai, B.;Katz, L.;Girman, C. J.
通讯作者：
Girman, C. J.
影响因子：
4.2
作者：
Frederich, Robert;Alexander, John H.;Mahaffey, Kenneth W.
通讯作者：
Mahaffey, Kenneth W.
影响因子：
2.9
作者：
Kimm H;Yun JE;Lee SH;Jang Y;Jee SH
通讯作者：
Jee SH
影响因子：
120.7
作者：
Fox, CS;Coady, S;Savage, PJ
通讯作者：
Savage, PJ
影响因子：
2.9
作者：
Choi, Nam-Kyong;Hahn, Seokyung;Park, Byung-Joo
通讯作者：
Park, Byung-Joo