Dipeptidyl Peptidase-4 Inhibitors and Risk of Heart Failure in Patients With Type 2 Diabetes Mellitus

Abstract

Our findings suggest that DPP-4i use did not increase the risk of HF compared with sulfonylurea. In addition, the risks for cardiovascular outcomes were not elevated in DPP-4i-treated patients compared with sulfonylurea-treated patients.

Cardiovascular safety of linagliptin compared with other oral glucose‐lowering agents in patients with type 2 diabetes: A sequential monitoring programme in routine care

“…Our results are consistent with a population‐based study leveraging the Korean Health Insurance Review and Assessment Service database, which assessed CV outcomes for linagliptin as compared with sulphonylureas in >60 000 1:1 PS‐matched pairs with T2D . The study found reductions in the risk of stroke (HR 0.71, 95% CI 0.62‐0.82) and myocardial infarction (HR 0.77, 95% CI 0.59‐1.02) associated with linagliptin use.…”

“…The mean age of the present study population was 55 years, with~20% of the population aged >65 years, and almost 60% of the study population were men. Individuals with a history of CV disease, including recent acute CV events, represented~10% of the sample and between 8% and 9% of patients used insulin at baseline.Our results are consistent with a population-based study leveraging the Korean Health Insurance Review and Assessment Service database, which assessed CV outcomes for linagliptin as compared with sulphonylureas in >60 000 1:1 PS-matched pairs with T2D 38. The study found reductions in the risk of stroke (HR 0.71, 95% CI 0.62-0.82) and myocardial infarction (HR 0.77, 95% CI 0.59-1.02) associated with linagliptin use.…”

Management of patients with diabetes and heart failure with reduced ejection fraction: An international comparison

“…Our data show that most physicians across countries continue to use statins in patients with diabetes and HFrEF, which may reflect unawareness of the lack of benefit observed in these trials or a stronger belief in the observational data. On the diabetes side, there remains uncertainty about the safety of DPP‐4 inhibitors, specifically saxagliptin and alogliptin, in patients with or at high risk of HF, although more recent data suggest that they are probably neutral from a cardiovascular standpoint . SGLT2 inhibitors show the most promise in improving outcomes in patients with diabetes and HF, as they appear to both prevent HF in patients at high cardiovascular risk and may also decrease mortality and HF hospitalizations in patients with established HF; however, SGLT2 inhibitor studies to date have only included a limited number of patients with established HF, with the definitive trials on‐going (NCT03057977, NCT02920918, NCT02653482, NCT03036124).…”

“…On the diabetes side, there remains uncertainty about the safety of DPP-4 inhibitors, specifically saxagliptin and alogliptin, in patients with or at high risk of HF, 23 although more recent data suggest that they are probably neutral from a cardiovascular standpoint. 24,25 SGLT2 inhibitors show the most promise in improving outcomes in patients with diabetes and HF, as they appear to both prevent HF in patients at high cardiovascular risk 8,26,27 and may also decrease mortality and HF hospitalizations in patients with established HF 4 ; however, SGLT2 inhibitor studies to date have only included a limited number of patients with established HF, with the definitive trials on-going (NCT03057977, NCT02920918, NCT02653482, NCT03036124). It is essential that more investigations are conducted on HF and diabetes medications in this subgroup of patients so that we understand the specific impact of these treatments on both disease conditions.…”

Practical strategies for improving outcomes in T2DM: The potential role of pioglitazone and DPP4 inhibitors

“…However, there is no apparent increased risk of heart failure when a broader population of T2DM patients is taken into account. Retrospective analysis found no increased risk of HF compared to use of sulfonylureas, 106 while a retrospective study based on the national Italian registry including 127 555 T2DM patients actually reported a reduction in the risk of hospitalization for HF as compared to that with use of sulfonylureas. 95 In the same population, no interclass difference was apparent for DPP4i with regard to the risk of hospitalization for HF.…”