Cardiovascular effect of DPP-4 inhibitors differs by CKD status

  • Huang TL & al.
  • PLoS ONE
  • 1 Jan 2019

  • International Clinical Digest
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Takeaway

  • For patients with type 2 diabetes (T2D) without chronic kidney disease (CKD), dipeptidyl peptidase-4 inhibitor (DPP-4i) use is associated with lower risks for major adverse cardiac events (MACE) and stroke.
  • For those with CKD, DPP-4is linked to higher hospitalization for heart failure (hHF) risk.

Why this matters

  • DPP-4i cardiovascular outcomes trial data have conflicted, and few patients with CKD have been studied.  

Study design

  • Retrospective study, T2D patients using oral glucose-lowering agents from Taiwan's National Health Insurance Research Database, with 8213 pairs with CKD and 12,313 pairs of non-CKD patients after propensity-score matching of DPP-4i users with nonusers.
  • MACE: composite of ischemic stroke, myocardial infarction, cardiovascular death.  
  • Funding: National Taiwan University Hospital, Ministry of Science and Technology, Taiwan.

Key results

  • In CKD cohort, DPP-4i exposure associated with:
    • 25% increase in hHF:
      • DPP-4i vs non-DPP-4i incidence/1000 person-years: 15.0 vs 9.9;
      • HR, 1.25 (P=.037); 
    • But not increased MACE risk (0.89; P=.144).
  • In non-CKD group, DPP-4i exposure was associated with:
    • Lower MACE risk, DPP-4i vs non-DPP-4i: 9.8 vs 12.6/1000 person-years;
    • HR, 0.73 (P=.0007).
  • Decrease mainly attributable to reduced ischemic stroke (7.4 vs 10.0/1000 person-years; HR, 0.68; P=.0003), not hHF (1.09; P=.631).

Limitations

  • No data for several possible confounders.
  • Possible database event/drug exposure misclassifications.