Dipeptidyl peptidase-4 inhibitor compared with sulfonylurea in combination with metformin: Cardiovascular and renal outcomes in a propensity-matched cohort study

Nam Hoon Kim, Kyoung Jin Kim, Jimi Choi, Juneyoung Lee, Jae Hyun Bae, Jee Hyun An, Hee Young Kim, Hye-Jin Yoo, Ji A Seo, Nan Hee Kim, Kyung Mook Choi, Sei-Hyun Baik, Sin Gon Kim

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Abstract

Background: To 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. Methods: From 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. Results: During a median follow-up of 19.6 months (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). Conclusions: This 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.

Original languageEnglish
Article number28
JournalCardiovascular Diabetology
Volume18
Issue number1
DOIs
Publication statusPublished - 2019 Mar 11

Fingerprint

Dipeptidyl-Peptidase IV Inhibitors
Metformin
Cohort Studies
Kidney
Hospitalization
Heart Failure
Type 2 Diabetes Mellitus
Myocardial Ischemia
Stroke
Propensity Score
Renal Replacement Therapy
Korea
Proportional Hazards Models
Chronic Kidney Failure
Therapeutics
Databases

Keywords

  • Cardiocerebrovascular disease
  • Dipeptidyl peptidase-4 inhibitors
  • End-stage renal disease
  • Heart failure
  • Sulfonylurea
  • Type 2 diabetes

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Cardiology and Cardiovascular Medicine

Cite this

@article{a2635d830f544e4b8af5a042e1fdbbf1,
title = "Dipeptidyl peptidase-4 inhibitor compared with sulfonylurea in combination with metformin: Cardiovascular and renal outcomes in a propensity-matched cohort study",
abstract = "Background: To 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. Methods: From 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. Results: During a median follow-up of 19.6 months (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). Conclusions: This 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.",
keywords = "Cardiocerebrovascular disease, Dipeptidyl peptidase-4 inhibitors, End-stage renal disease, Heart failure, Sulfonylurea, Type 2 diabetes",
author = "Kim, {Nam Hoon} and Kim, {Kyoung Jin} and Jimi Choi and Juneyoung Lee and Bae, {Jae Hyun} and An, {Jee Hyun} and Kim, {Hee Young} and Hye-Jin Yoo and Seo, {Ji A} and Kim, {Nan Hee} and Choi, {Kyung Mook} and Sei-Hyun Baik and Kim, {Sin Gon}",
year = "2019",
month = "3",
day = "11",
doi = "10.1186/s12933-019-0835-z",
language = "English",
volume = "18",
journal = "Cardiovascular Diabetology",
issn = "1475-2840",
publisher = "BioMed Central",
number = "1",

}

TY - JOUR

T1 - Dipeptidyl peptidase-4 inhibitor compared with sulfonylurea in combination with metformin

T2 - Cardiovascular and renal outcomes in a propensity-matched cohort study

AU - Kim, Nam Hoon

AU - Kim, Kyoung Jin

AU - Choi, Jimi

AU - Lee, Juneyoung

AU - Bae, Jae Hyun

AU - An, Jee Hyun

AU - Kim, Hee Young

AU - Yoo, Hye-Jin

AU - Seo, Ji A

AU - Kim, Nan Hee

AU - Choi, Kyung Mook

AU - Baik, Sei-Hyun

AU - Kim, Sin Gon

PY - 2019/3/11

Y1 - 2019/3/11

N2 - Background: To 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. Methods: From 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. Results: During a median follow-up of 19.6 months (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). Conclusions: This 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.

AB - Background: To 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. Methods: From 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. Results: During a median follow-up of 19.6 months (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). Conclusions: This 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.

KW - Cardiocerebrovascular disease

KW - Dipeptidyl peptidase-4 inhibitors

KW - End-stage renal disease

KW - Heart failure

KW - Sulfonylurea

KW - Type 2 diabetes

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U2 - 10.1186/s12933-019-0835-z

DO - 10.1186/s12933-019-0835-z

M3 - Article

C2 - 30857540

AN - SCOPUS:85062841930

VL - 18

JO - Cardiovascular Diabetology

JF - Cardiovascular Diabetology

SN - 1475-2840

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