Dipeptidyl peptidase-4 inhibitor compared with sulfonylurea in combination with metformin: cardiovascular and renal outcomes in a propensity-matched cohort study
Dipeptidyl peptidase-4 inhibitor compared with sulfonylurea in combination with metformin: cardiovascular and renal outcomes in a propensity-matched cohort study
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DOI：
10.1186/s12933-019-0835-z
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发表时间：
2019-03-11
影响因子：
9.3
通讯作者：
Kim, Nam Hoon
中科院分区：
文献类型：
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作者：
Kim, Kyoung Jin;Choi, Jimi;Kim, Nam Hoon
背景为了确定二肽基肽酶 4 抑制剂 (DPP4i) 与磺酰脲类 (SU) 联合二甲双胍相比，对基于人群的 2 型糖尿病患者主要心脑血管和肾脏结局风险的影响。方法从韩国全国队列 (2008-2013) 中，选择了 23,674 名接受 DPP4i 加二甲双胍或 SU 加二甲双胍治疗的 2 型糖尿病患者，与倾向得分相匹配。通过 Cox 比例风险模型评估复合心脑血管事件，包括突发缺血性心脏病 (IHD)、缺血性中风 (IS)、心力衰竭住院 (HHF) 和心脑血管死亡，以及肾脏事件，包括突发终末期肾病或开始肾脏替代治疗。结果在 19.6 个月的中位随访期间（四分位距 7.2-36.4），762发生复合心脑血管事件和17例终末期肾脏事件。与 SU 组相比，DPP4i 组 IHD（风险比 [HR]，1.00；95% CI 0.81-1.23）、IS（HR，0.95；95% CI 0.74-1.23）或心脑血管死亡（HR，0.74；95% CI 0.46-1.18）风险无显着差异。同样，DPP4i 治疗与终末期肾脏结局的风险无关（HR，1.23；95% CI 0.41-3.62）。然而，DPP4i 组的 HHF 风险显着高于 SU 组（HR，1.47；95% CI 1.07-2.04）。结论：该真实世界数据库分析表明，与 SU 治疗相比，DPP4i 治疗并未增加主要心血管和肾脏结局的总体风险。然而，DPP4i 相关的 HHF 风险仍然很大。
BackgroundTo determine the impact of dipeptidyl peptidase-4 inhibitor (DPP4i) on the risk of major cardiocerebrovascular and renal outcomes compared with sulfonylurea (SU) combined with metformin in patients with type 2 diabetes from a population-based cohort.MethodsFrom a nationwide cohort in Korea (2008-2013), 23,674 patients with type 2 diabetes treated with DPP4i plus metformin or SU plus metformin were selected and matched by propensity score. Composite cardiocerebrovascular events including incident ischemic heart disease (IHD), ischemic stroke (IS), hospitalization for heart failure (HHF), and cardiocerebrovascular death, as well as renal events including incident end-stage renal disease or initiation of renal-replacement therapy were assessed by Cox proportional-hazards models.ResultsDuring a median follow-up of 19.6months (interquartile range 7.2-36.4), 762 composite cardiocerebrovascular events and 17 end-stage renal events occurred. There was no significant difference in the risk of IHD (hazard ratio [HR], 1.00; 95% CI 0.81-1.23), IS (HR, 0.95; 95% CI 0.74-1.23), or cardiocerebrovascular death (HR, 0.74; 95% CI 0.46-1.18) in the DPP4i group compared to that in the SU group. Likewise, DPP4i therapy was not associated with the risk of end-stage renal outcomes (HR, 1.23; 95% CI 0.41-3.62). However, the risk of HHF was significantly higher in the DPP4i group than in the SU group (HR, 1.47; 95% CI 1.07-2.04).ConclusionsThis real-world database analysis showed that DPP4i therapy did not increase the overall risk of major cardiovascular and renal outcomes compared to SU therapy. However, the DPP4i-associated risk of HHF remained significant.