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Dipeptidyl Peptidase‐4 Inhibitors and Heart Failure Exacerbation in the Veteran Population: An Observational Study
Author(s) -
Cobretti Michael R.,
Bowman Benjamin,
Grabarczyk Ted,
Potter Emily
Publication year - 2018
Publication title -
pharmacotherapy: the journal of human pharmacology and drug therapy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.227
H-Index - 109
eISSN - 1875-9114
pISSN - 0277-0008
DOI - 10.1002/phar.2085
Subject(s) - observational study , dipeptidyl peptidase 4 , exacerbation , heart failure , medicine , population , dipeptidyl peptidase , endocrinology , diabetes mellitus , type 2 diabetes , biology , environmental health , enzyme , biochemistry
Objectives The dipeptidyl peptidase‐4 inhibitors ( DPP ‐4 inhibitors) are effective modulators of fasting and postprandial hyperglycemia in patients with type 2 diabetes mellitus (T2 DM ). In 2013 the Saxagliptin Assessment of Vascular Outcomes Recorded in Patients with Diabetes Mellitus–Thrombolysis in Myocardial Infarction 53 ( SAVOR ‐ TIMI 53) clinical trial found an increased risk of heart failure exacerbation, as a secondary outcome, among patients treated with saxagliptin. This study examines the safety of DPP ‐4 inhibitors as a class in T2 DM in relation to risk of heart failure exacerbations. Methods Retrospective cohort study of two groups of patients using data from the national Department of Veteran's Affairs ( VA ) Health Care System: patients initially prescribed DPP ‐4 inhibitors with or without second‐generation sulfonylureas and/or metformin (exposed group) compared with patients initially prescribed only second‐generation sulfonylureas and/or metformin (unexposed group) between August 1, 2013, and August 30, 2016. The primary aim of this study was to determine the difference in 1‐year heart failure exacerbation rate in patients with T2 DM between the exposed and unexposed groups. Data were analyzed using the χ 2 Student t test and Kaplan‐Meier analysis. Significance was set at p<0.05. Results The study evaluated 672,265 patients: 33,614 patients in the exposed group and 638,651 patients in the unexposed group. Overall, 130 (0.38%) heart failure exacerbations were documented in the exposed group, and 2222 (0.34%) heart failure exacerbations were documented in the unexposed group; the difference in exacerbation rate was nonsignificant between groups (p=0.24). In a subgroup analysis of patients with a baseline diagnosis of heart failure, the difference in rate of heart failure exacerbations remained nonsignificant (p=0.334). Conclusions Patients in the veteran population with T2 DM treated with DPP ‐4 inhibitors did not demonstrate a significant increase in risk for heart failure exacerbation, regardless of whether a patient had been previously diagnosed with heart failure. This finding potentially supports safe usage of DPP ‐4 inhibitors in this patient population regardless of heart failure diagnosis.