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No increased risk of cardiovascular events in older adults initiating dipeptidyl peptidase‐4 inhibitors vs therapeutic alternatives
Author(s) -
Gokhale Mugdha,
Buse John B.,
Jonsson Funk Michele,
Lund Jennifer,
Pate Virginia,
Simpson Ross J.,
Stürmer Til
Publication year - 2017
Publication title -
diabetes, obesity and metabolism
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.445
H-Index - 128
eISSN - 1463-1326
pISSN - 1462-8902
DOI - 10.1111/dom.12906
Subject(s) - hazard ratio , medicine , dipeptidyl peptidase 4 , myocardial infarction , stroke (engine) , confidence interval , lower risk , heart failure , dipeptidyl peptidase 4 inhibitor , relative risk , proportional hazards model , ace inhibitor , dipeptidyl peptidase , gastroenterology , pharmacology , endocrinology , diabetes mellitus , angiotensin converting enzyme , type 2 diabetes , enzyme , chemistry , blood pressure , mechanical engineering , biochemistry , engineering
Aim To compare the cardiovascular ( CV ) risk associated with dipeptidyl peptidase‐4 ( DPP ‐4) inhibitors relative to sulphonylureas ( SUs ) and thiazolidinediones ( TZDs ). Methods During 2007 to 2013, using M edicare data for beneficiaries aged >65 years, we identified the following 2 cohorts of new‐users, who had not been exposed to the drugs being compared in the 6 months before initiation: (1) DPP ‐4 inhibitor vs SU initiators and (2) DPP ‐4 inhibitor vs TZD initiators. Using propensity‐score‐adjusted C ox models accounting for competing risk by death, we estimated the hazard ratios ( HRs ), risk differences and 95% confidence intervals ( CIs ) for myocardial infarction ( MI ), stroke, hospitalization for heart failure ( HF ), and a combined outcome ( MI , stroke, all‐cause mortality). Results In the DPP ‐4 inhibitor vs SU comparison, there were 30 130 DPP ‐4 inhibitor initiators and 68 382 SU initiators. Their mean age was 75 years, 41% were men and 55% had a baseline CV condition. The HR for the composite outcome was 0.75 (95% CI 0.72‐0.79) over a median treatment duration of 1 year, but the 1‐year risks of MI were 1.00 (95% CI 0.89‐1.12) and 1.47 (95% CI 1.38‐1.56) per 100 patients for DPP ‐4 inhibitors and SUs , respectively, and the corresponding stroke risks were 0.98 (95% CI 0.87‐1.10) and 1.09 (95% CI 1.01‐1.17). For the DPP ‐4 inhibitor vs TZD comparison, there were 20 596 DPP ‐4 inhibitor initiators and 13 526 TZD initiators without previous HF . Their mean age was 74 years, 42% were men and 30% had a baseline CV event. The composite outcome HR was 0.94 (95% CI 0.86‐1.02) over a median treatment duration of 1 year. The 1‐year risk for MI was ~0.90 and for stroke it was ~0.80 per 100 patients in both DPP ‐4 inhibitor and TZD initiators. Conclusion Although limited by the short treatment period, the present study suggests there is no increased short‐term risk of MI , stroke or HF with DPP ‐4 inhibitors vs SUs / TZDs .