Aims Oral glucose-lowering medications are associated with excess risk of heart failure (HF). Given the absence of comparative data among drug classes, we performed a retrospective study in 32 Health Services of 16 Italian regions accounting for a population of 18 million individuals, to assess the association between HF risk and use of sulphonylureas, DPP-4i, and glitazones. Methods and results We extracted data on patients with type 2 diabetes who initiated treatment with DPP-4i, thiazolidinediones, or sulphonylureas alone or in combination with metformin during an accrual time of 2 years. The endpoint was hospitalization for HF (HHF) occurring after the first 6 months of therapy, and the observation was extended for up to 4 years. A total of 127 555 patients were included, of whom 14.3% were on DPP-4i, 72.5% on sulphonylurea, 13.2% on thiazolidinediones, with average 70.7% being on metformin as combination therapy. Patients in the three groups differed significantly for baseline characteristics: age, sex, Charlson index, concurrent medications, and previous cardiovascular events. During an average 2.6-year follow-up, after adjusting for measured confounders, use of DPP-4i was associated with a reduced risk of HHF compared with sulphonylureas [hazard ratio (HR) 0.78; 95% confidence interval (CI) 0.62-0.97; P = 0.026]. After propensity matching, the analysis was restricted to 39 465 patients, and the use of DPP-4i was still associated with a lower risk of HHF (HR 0.70; 95% CI 0.52-0.94; P = 0.018). Conclusion In a very large observational study, the use of DPP-4i was associated with a reduced risk of HHF when compared with sulphonylureas.
Risk of hospitalization for heart failure in patients with type 2 diabetes newly treated with DPP-4 inhibitors or other oral glucose-lowering medications: A retrospective registry study on 127,555 patients from the Nationwide OsMed Health-DB Database / Fadini, G. P.; Avogaro, A.; Degli Esposti, L.; Russo, P.; Saragoni, S.; Buda, S.; Rosano, G.; Pecorelli, S.; Pani, L.; Martinetti, S.; Mero, P.; Raeli, L.; Migliazza, S.; Dellagiovanna, M.; Cerra, C.; Gambera, M.; Piccinelli, R.; Zambetti, M.; Atzeni, F.; Valsecchi, V.; Deluca, P.; Scopinaro, E.; Moltoni, D.; Pini, E.; Leoni, O.; Oria, C.; Papagni, M.; Nosetti, G.; Caldiroli, E.; Moser, V.; Roni, R.; Polverino, A.; Bovo, C.; Mezzalira, L.; Andretta, M.; Trentin, L.; Palcic, S.; Pettinelli, A.; Arbo, A.; Bertola, A.; Capparoni, G.; Cattaruzzi, C.; Marcuzzo, L.; Rosa, F. V.; Basso, B.; Saglietto, M.; Delucis, S.; Prioli, M.; Filippi, R.; Coccini, A.; Ghia, M.; Sanfelici, F.; Radici, S.; Scanavacca, P.; Campi, A.; Bianchi, S.; Verzola, A.; Morini, M.; Borsari, M.; Danielli, A.; Dal Maso, M.; Marsiglia, B.; Vujovic, B.; Pisani, M.; Bonini, P.; Lena, F.; Aletti, P.; Marcobelli, A.; Sagratella, S.; Fratini, S.; Bartolini, F.; Riccioni, G.; Meneghini, A.; Di Turi, R.; Fano, V.; Blasi, A.; Pagnozzi, E.; Quintavalle, G.; D'Avenia, P.; De Matthaeis, M. C.; Ferrante, F.; Crescenzi, S.; Marziale, L.; Venditti, P.; Bianchi, C.; Senesi, I.; Baci, R.; De Carlo, I.; Lavalle, A.; Trofa, G.; Marcello, G.; Pagliaro, C.; Troncone, C.; Farina, G.; Tari, M. G.; Motola, G.; De Luca, F.; Saltarelli, M. L.; Granieri, C.; Vulnera, M.; Palumbo, L.; La Viola, F.; Florio, L.; De Francesco, A. E.; Costantino, D.; De Francesco, A. E.; Rapisarda, F.; Lazzaro, P. L.; Pastorello, M.; Parlli, M.; Visconti, M.; Uomo, I.; Sanna, P.; Lombardo, F.. - In: EUROPEAN HEART JOURNAL. - ISSN 0195-668X. - 36:36(2015), pp. 2454-2462. [10.1093/eurheartj/ehv301]
Risk of hospitalization for heart failure in patients with type 2 diabetes newly treated with DPP-4 inhibitors or other oral glucose-lowering medications: A retrospective registry study on 127,555 patients from the Nationwide OsMed Health-DB Database
Degli Esposti L.;Pani L.;Andretta M.;Campi A.;Pisani M.;Blasi A.;Farina G.;De Luca F.;Palumbo L.;Rapisarda F.;Visconti M.;Lombardo F.
2015
Abstract
Aims Oral glucose-lowering medications are associated with excess risk of heart failure (HF). Given the absence of comparative data among drug classes, we performed a retrospective study in 32 Health Services of 16 Italian regions accounting for a population of 18 million individuals, to assess the association between HF risk and use of sulphonylureas, DPP-4i, and glitazones. Methods and results We extracted data on patients with type 2 diabetes who initiated treatment with DPP-4i, thiazolidinediones, or sulphonylureas alone or in combination with metformin during an accrual time of 2 years. The endpoint was hospitalization for HF (HHF) occurring after the first 6 months of therapy, and the observation was extended for up to 4 years. A total of 127 555 patients were included, of whom 14.3% were on DPP-4i, 72.5% on sulphonylurea, 13.2% on thiazolidinediones, with average 70.7% being on metformin as combination therapy. Patients in the three groups differed significantly for baseline characteristics: age, sex, Charlson index, concurrent medications, and previous cardiovascular events. During an average 2.6-year follow-up, after adjusting for measured confounders, use of DPP-4i was associated with a reduced risk of HHF compared with sulphonylureas [hazard ratio (HR) 0.78; 95% confidence interval (CI) 0.62-0.97; P = 0.026]. After propensity matching, the analysis was restricted to 39 465 patients, and the use of DPP-4i was still associated with a lower risk of HHF (HR 0.70; 95% CI 0.52-0.94; P = 0.018). Conclusion In a very large observational study, the use of DPP-4i was associated with a reduced risk of HHF when compared with sulphonylureas.
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