Risk of hospitalization for heart failure in patients with type 2 diabetes newly treated with DPP-4 inhibitors or other oral glucose-lowering medications: A retrospective registry study on 127,555 patients from the Nationwide OsMed Health-DB Database

Gian Paolo Fadini, Angelo Avogaro, Luca Degli Esposti, Pierluigi Russo, Stefania Saragoni, Stefano Buda, Giuseppe Rosano, Sergio Pecorelli, Luca Pani, S. Martinetti, P. Mero, L. Ræli, S. Migliazza, M. Dellagiovanna, C. Cerra, M. Gambera, R. Piccinelli, M. Zambetti, F. Atzeni, V. ValsecchiP. Deluca, E. Scopinaro, D. Moltoni, E. Pini, O. Leoni, C. Oria, M. Papagni, G. Nosetti, E. Caldiroli, V. Moser, R. Roni, A. Polverino, C. Bovo, L. Mezzalira, M. Andretta, L. Trentin, S. Palcic, A. Pettinelli, A. Arbo, A. Bertola, G. Capparoni, C. Cattaruzzi, L. Marcuzzo, F. V. Rosa, B. Basso, M. Saglietto, S. Delucis, M. Prioli, R. Filippi, A. Coccini, M. Ghia, F. Sanfelici, S. Radici, P. Scanavacca, A. Campi, S. Bianchi, A. Verzola, M. Morini, M. Borsari, A. Danielli, M. Dal Maso, B. Marsiglia, B. Vujovic, M. Pisani, P. Bonini, F. Lena, P. Aletti, A. Marcobelli, S. Sagratella, S. Fratini, F. Bartolini, G. Riccioni, A. Meneghini, R. Di Turi, V. Fano, A. Blasi, E. Pagnozzi, G. Quintavalle, P. D'Avenia, M. C. De Matthæis, F. Ferrante, S. Crescenzi, L. Marziale, P. Venditti, C. Bianchi, I. Senesi, R. Baci, I. De Carlo, A. Lavalle, G. Trofa, G. Marcello, C. Pagliaro, C. Troncone, G. Farina, M. G. Tari, G. Motola, F. De Luca, M. L. Saltarelli, C. Granieri, M. Vulnera, L. Palumbo, F. La Viola, L. Florio, A. E. De Francesco, D. Costantino, A. E. De Francesco, F. Rapisarda, P. L. Lazzaro, M. Pastorello, M. Parlli, M. Visconti, I. Uomo, P. Sanna, F. Lombardo

Research output: Contribution to journalArticle

Abstract

Aims Oral glucose-lowering medications are associated with excess risk of heart failure (HF). Given the absence of comparative data among drug classes, we performed a retrospective study in 32 Health Services of 16 Italian regions accounting for a population of 18 million individuals, to assess the association between HF risk and use of sulphonylureas, DPP-4i, and glitazones. Methods and results We extracted data on patients with type 2 diabetes who initiated treatment with DPP-4i, thiazolidinediones, or sulphonylureas alone or in combination with metformin during an accrual time of 2 years. The endpoint was hospitalization for HF (HHF) occurring after the first 6 months of therapy, and the observation was extended for up to 4 years. A total of 127 555 patients were included, of whom 14.3% were on DPP-4i, 72.5% on sulphonylurea, 13.2% on thiazolidinediones, with average 70.7% being on metformin as combination therapy. Patients in the three groups differed significantly for baseline characteristics: age, sex, Charlson index, concurrent medications, and previous cardiovascular events. During an average 2.6-year follow-up, after adjusting for measured confounders, use of DPP-4i was associated with a reduced risk of HHF compared with sulphonylureas [hazard ratio (HR) 0.78; 95% confidence interval (CI) 0.62-0.97; P = 0.026]. After propensity matching, the analysis was restricted to 39 465 patients, and the use of DPP-4i was still associated with a lower risk of HHF (HR 0.70; 95% CI 0.52-0.94; P = 0.018). Conclusion In a very large observational study, the use of DPP-4i was associated with a reduced risk of HHF when compared with sulphonylureas.

Original languageEnglish
Pages (from-to)2454-2462
Number of pages9
JournalEuropean Heart Journal
Volume36
Issue number36
DOIs
Publication statusPublished - Sep 21 2015

Keywords

  • Diabetes
  • Epidemiology
  • Heart failure
  • Incretin
  • Medications

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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    Fadini, G. P., Avogaro, A., Degli Esposti, L., Russo, P., Saragoni, S., Buda, S., Rosano, G., Pecorelli, S., Pani, L., Martinetti, S., Mero, P., Ræli, L., Migliazza, S., Dellagiovanna, M., Cerra, C., Gambera, M., Piccinelli, R., Zambetti, M., Atzeni, F., ... Lombardo, F. (2015). Risk of hospitalization for heart failure in patients with type 2 diabetes newly treated with DPP-4 inhibitors or other oral glucose-lowering medications: A retrospective registry study on 127,555 patients from the Nationwide OsMed Health-DB Database. European Heart Journal, 36(36), 2454-2462. https://doi.org/10.1093/eurheartj/ehv301