Risks of cardiovascular diseases associated with dipeptidyl peptidase-4 inhibitors and other antidiabetic drugs in patients with type 2 diabetes: a nation-wide longitudinal study.
Risks of cardiovascular diseases associated with dipeptidyl peptidase-4 inhibitors and other antidiabetic drugs in patients with type 2 diabetes: a nation-wide longitudinal study.
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DOI：
10.1186/s12933-016-0350-4
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发表时间：
2016-03-01
影响因子：
9.3
通讯作者：
Wu JS
中科院分区：
文献类型：
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作者：
Ou HT;Chang KC;Li CY;Wu JS
几种抗糖尿病药物（即，磺酰脲类; SU，罗格列酮）与2型糖尿病（T2 DM）患者心血管疾病（CVD）风险增加相关。二肽基肽酶-4抑制剂（DPP 4 i）是近年来出现的新型抗糖尿病药物。大多数研究仅将DPP 4 i与安慰剂或SU进行比较，或针对感兴趣的特定CVD事件（即，心力衰竭; HF）。DPP 4 i与其他抗糖尿病药物（即，二甲双胍、噻唑烷二酮类、氯茴苯酸类、阿卡波糖和胰岛素）仍然很少。本研究旨在评估DPP 4 i与其他抗糖尿病药物的CVD（包括缺血性卒中、心肌梗死（MI）和HF）和低血糖的比较风险。我们使用台湾全民健康保险研究数据库。2009-2010年，共确定了123，050例新处方口服降糖药治疗的T2 DM患者，并随访至2013年。结局终点包括CVD事件的复合终点：因缺血性卒中、MI和HF以及低血糖而住院。应用时变考克斯比例风险回归评估各种降糖药物的时间至事件风险，并根据患者的人口统计学、合并症、糖尿病并发症和合并用药进行调整。分别对有和无CVD病史的患者进行了额外的分析。与非DPP 4 i使用者相比，DPP 4 i使用者的CVD风险显着降低（调整后的风险比[aHR]：0.83，95%置信区间[CI]：0.76-0.91）。与DPP 4 i使用者相比，氯格列奈类（aHR 1.3，95% CI 1.20-1.43）和胰岛素使用者（aHR 3.73，95% CI 3.35，4.14）的复合CVD以及卒中、MI、HF和低血糖的风险显著更高。此外，与DPP 4 i使用者相比，二甲双胍使用者的复合CVD风险（aHR 0.87，95% CI 0.79-0.94）以及MI、HF和低血糖风险显著降低。尽管吡格列酮使用者的CVD风险有降低的趋势，但不能排除适应症的潜在混杂作用。与非DPP 4 i使用者相比，DPP 4 i治疗的T2 DM患者的CVD风险较低，二甲双胍使用者除外。本文的在线版本（doi：10.1186/s12933-016-0350-4）包含补充材料，可供授权用户使用。
Several antidiabetic drugs (i.e., sulfonylureas; SU, rosiglitazone) have been reported to be associated with increased risks of cardiovascular diseases (CVD) in patients with type 2 diabetes mellitus (T2DM). Dipeptidyl peptidase-4 inhibitors (DPP4i) are newly available antidiabetic drugs. Most studies only compared DPP4i with a placebo or SU, or targeted a specific CVD event of interest (i.e., heart failure; HF). Comparative research of CVD risks of DPP4i with other antidiabetic drugs (i.e., metformin, thiazolidinediones, meglitinides, acarbose, and insulin) remains scarce. This study was aimed to assess comparative risks of CVD, including ischemic stroke, myocardial infarction (MI) and HF, and hypoglycemia of DPP4i with other antidiabetic drugs. We utilized Taiwan’s National Health Insurance Research Database. A total of 123,050 T2DM patients newly prescribed oral antidiabetic treatments were identified in 2009–2010 and followed until 2013. Outcome endpoints included a composite of CVD events: hospitalizations for ischemic stroke, MI and HF, and hypoglycemia. Time-varying Cox proportional hazards regression was applied to assess the time to event hazards of various antidiabetic drugs, adjusted for patients’ demographics, comorbidity, diabetic complications, and co-medications. Additional analyses were performed for the patients with and without CVD history, respectively. DPP4i users had significantly lower CVD risks as compared to that of non-DPP4i users (adjusted hazard ratio [aHR]: 0.83, 95 % confidence interval [CI]: 0.76–0.91). Compared to DPP4i users, meglitinides (aHR 1.3, 95 % CI 1.20–1.43) and insulin users (aHR 3.73, 95 % CI 3.35, 4.14) had significantly higher risks for composite CVD, as well as those for stroke, MI, HF, and hypoglycemia. Additionally, metformin users had significantly lower risks for composite CVD risk (aHR 0.87, 95 % CI 0.79–0.94), as well as those for MI, HF, and hypoglycemia, as compared to those of DPP4i users. Although there was a trend toward low CVD risks in pioglitazone users, the role of potential confounding by indication cannot be excluded. DPP4i-treated T2DM patients had lower risks for CVD as compared to those for non-DPP4i users, except metformin users. The online version of this article (doi:10.1186/s12933-016-0350-4) contains supplementary material, which is available to authorized users.