Antihyperglycemic drugs use and new‐onset atrial fibrillation in elderly patients

Abstract

In this population, use of dipeptidyl peptidase 4 inhibitor was associated with a low risk of NAF. Insulin use was associated with a significant increase in the risk of NAF during the long-term follow-up.

Atrial fibrillation and type 2 diabetes: Prevalence, etiology, pathophysiology and effect of anti‐diabetic therapies

“…After adjusting for age, sex, comorbidities and concurrent medication, the risk was higher among insulin users than among non‐users (OR, 1.58; 95% CI, 1.37‐1.82). Patients who took DPP‐4 inhibitors were at lower risk of developing AF than were non‐users (OR, 0.65; 95%, CI 0.45‐0.93) …”

“…Patients who took DPP-4 inhibitors were at lower risk of developing AF than were non-users (OR, 0.65; 95%, CI 0.45-0.93). 68 Based on large studies evaluating intensive insulin therapies and health outcomes, there is a concern that insulin treatment, through hypoglycaemia which activates the sympathetic nervous system, could increase the rate of NAF. However, the ORIGIN trial did not show an increase in the rate of NAF in the glargine group compared with the placebo group.…”

Heightened risk of intensive rate control in patients with atrial fibrillation who are obese or have type 2 diabetes: A critical review and re‐evaluation

“…Marked weight loss decreases epicardial fat mass, improves LA geometry, and alleviates the burden of AF . Insulin promotes epicardial adipogenesis and can thereby aggravate the atrial myopathy and stimulate AF . In contrast, drugs used in diabetes that ameliorate the inflammatory state of epicardial fat (eg, statins and metformin) are accompanied by improvement in LA structure and a reduction in the incidence and prevalence of AF .…”

Research update for articles published in EJCI in 2017

“…We had earlier demonstrated that patients who were administered dipeptidyl peptidase 4 (DPP4) inhibitors had a lower risk of developing new‐onset atrial fibrillation (NAF) than nonusers among the elderly . Simultaneously, another research group in Taiwan from which they identified 16 017 patients in the cohort of DPP4 inhibitor users and 74 863 patients in the cohort of DPP4 inhibitor nonusers and reported that DPP4 inhibitor therapy is associated with a decreased risk of developing NAF .…”

“…We had earlier demonstrated that patients who were administered dipeptidyl peptidase 4 (DPP4) inhibitors had a lower risk of developing new-onset atrial fibrillation (NAF) than nonusers among the elderly. 27 Simultaneously, another research group in Taiwan from which they identified 16 017 patients in the cohort of DPP4 inhibitor users and 74 863 patients in the cohort of DPP4 inhibitor nonusers and reported that DPP4 inhibitor therapy is associated with a decreased risk of developing NAF. 28 However, another study identified 401 linagliptin users who had acute coronary syndrome or acute ischaemic stroke and 802 controls (matched with patient characteristics, baseline comorbidities, medication prescribed 90 days since indexed hospitalization and index year and month by propensity score).…”