RT Journal Article
SR Electronic
T1 Hospitalisation for heart failure and mortality associated with dipeptidyl peptidase 4 (DPP-4) inhibitor use in an unselected population of subjects with type 2 diabetes: a nested case–control study
JF BMJ Open
JO BMJ Open
FD British Medical Journal Publishing Group
SP e007959
DO 10.1136/bmjopen-2015-007959
VO 5
IS 6
A1 Carlo B Giorda
A1 Roberta Picariello
A1 Barbara Tartaglino
A1 Lisa Marafetti
A1 Fabiana Di Noi
A1 Annalisa Alessiato
A1 Giuseppe Costa
A1 Roberto Gnavi
YR 2015
UL http://bmjopen.bmj.com/content/5/6/e007959.abstract
AB Objective The SAVOR TIMI–53 study reported a significant increase in the risk of hospitalisation for heart failure (HF) in patients treated with a DPP-4 inhibitor (DPP-4i) in comparison with placebo. A recent case-control study in part confirmed this risk signal. Our aim was to compare the occurrence of HF in relation to DPP-4i use versus any antidiabetic treatment.Design Population-based matched case-control study conducted using administrative data.Setting The Italian Region of Piedmont (4.4 million inhabitants).Participants From a database of 282 000 patients treated with antidiabetic drugs, we identified 14 613 hospitalisations for HF, 7212 incident cases, and 1727 hospital re-admissions between 2008 and 2012; each case was matched for gender, age and antidiabetic therapy with 10 controls; cases and controls were compared for exposure to DPP-4i.Outcome measures ORs and 95% CIs were calculated by fitting a conditional logistic model. All analyses were adjusted for available risk factors for HF.Results We found no increased risk of hospitalisation for HF associated with the use of DPP-4i (OR for admission for HF 1.00 (0.94 to 1.07), incident HF1.01 (0.92 to 1.11), recurrent HF 1.02 (0.84 to 1.22)). All-cause mortality was 6% lower in DPP-4i users (p<0.001), whereas insulin users showed an excess of risk for any type of hospital admission (19%) and death (20%) (p<0.001).Conclusions Our findings suggest that, in an unselected population of diabetic patients, the use of DPP-4i is not associated with an increased risk of HF. The favourable impact on all-cause mortality should be viewed with caution and also other explanations investigated.