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Effects of DPP-4 inhibitors on cardiovascular outcomes in patients with type 2 diabetes and end-stage renal disease
- Source :
- International journal of cardiology. 218
- Publication Year :
- 2016
-
Abstract
- Background Recent clinical trials have evaluated the cardiovascular outcomes of dipeptidyl peptidase-4 ( DPP-4) inhibitors in patients with type 2 diabetes mellitus (T2DM), but those with end-stage renal disease (ESRD) were ineligible for participation in these trials. We aimed to characterize the impact of DPP-4 inhibitors on major adverse cardiovascular events (MACEs) in patients with T2DM and ESRD undergoing chronic dialysis. Methods This nationwide observational study utilized data from 3556 patients aged ≥20years with T2DM and ESRD who initiated treatment with DPP-4 inhibitors between 1 March 2009 and 31 June 2013, retrieved from Taiwan's National Health Insurance Research Database. Each DPP-4 inhibitor user was matched to a non-user control subject using propensity scores. The primary outcomes were all-cause mortality and MACEs (ischemic stroke and myocardial infarction). The secondary outcomes were hospitalization for heart failure and hypoglycemia. All subjects were followed until death or 31 December 2013. Results Compared with non-users, DPP-4 inhibitor users had lower risks of all-cause mortality (hazard ratio [HR] 0.43, 95% confidence interval [CI] 0.39–0.47), MACEs (HR 0.76, 95% CI 0.65–0.90), and ischemic stroke (HR 0.77, 95% CI 0.61–0.97); the risks of myocardial infarction and hospitalization for heart failure and hypoglycemia did not differ. This treatment effect remained consistent in subgroup analyses according to age, sex, comorbidities, dialysis modality, and insulin use. Conclusions In this nationwide ESRD cohort, DPP-4 inhibitor use was associated with reduced risks of all-cause mortality and ischemic stroke.
- Subjects :
- Male
medicine.medical_specialty
medicine.medical_treatment
Taiwan
Dipeptidyl peptidase-4 inhibitor
Type 2 diabetes
030204 cardiovascular system & hematology
Hypoglycemia
End stage renal disease
03 medical and health sciences
0302 clinical medicine
Diabetes mellitus
Internal medicine
medicine
Humans
030212 general & internal medicine
Myocardial infarction
Intensive care medicine
Propensity Score
Dialysis
Aged
Dipeptidyl-Peptidase IV Inhibitors
business.industry
Hazard ratio
Middle Aged
medicine.disease
Hospitalization
Diabetes Mellitus, Type 2
Cardiovascular Diseases
Kidney Failure, Chronic
Female
Cardiology and Cardiovascular Medicine
business
medicine.drug
Subjects
Details
- ISSN :
- 18741754
- Volume :
- 218
- Database :
- OpenAIRE
- Journal :
- International journal of cardiology
- Accession number :
- edsair.doi.dedup.....8a50d4dff045101f21b7fc099aca0bea