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Cardiovascular Outcomes of Dipeptidyl Peptidase-4 Inhibitors in Elderly Patients With Type 2 Diabetes: A Nationwide Study

  • Chia-Jen Shih
    Affiliations
    School of Medicine, National Yang-Ming University, Taipei, Taiwan

    Department of Medicine, Taipei Veterans General Hospital, Yuanshan Branch, Yilan, Taiwan
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  • Hung-Ta Chen
    Affiliations
    School of Medicine, National Yang-Ming University, Taipei, Taiwan

    Division of Endocrinology and Metabolism, Department of Medicine, Taipei City Hospital, Heping Fuyou Branch, Taipei, Taiwan
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  • Shu-Chen Kuo
    Affiliations
    School of Medicine, National Yang-Ming University, Taipei, Taiwan

    National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Miaoli County, Taiwan

    Division of Infectious Diseases, Taipei Veterans General Hospital, Taipei, Taiwan
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  • Shuo-Ming Ou
    Correspondence
    Shuo-Ming Ou, MD, Department of Nephrology, Taipei Veterans General Hospital, Taipei, Taiwan 11217.
    Affiliations
    School of Medicine, National Yang-Ming University, Taipei, Taiwan

    Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
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  • Yung-Tai Chen
    Correspondence
    Address correspondence to Yung-Tai Chen, MD, Department of Nephrology, Taipei City Hospital, Heping, Fuyou Branch, Taipei, Taiwan 112.
    Affiliations
    School of Medicine, National Yang-Ming University, Taipei, Taiwan

    Division of Nephrology, Department of Medicine, Taipei City Hospital, Heping, Fuyou Branch, Taipei, Taiwan
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Published:November 20, 2015DOI:https://doi.org/10.1016/j.jamda.2015.10.009

      Abstract

      Objectives

      The elderly (aged ≥65 years) population with type 2 diabetes (T2D) is growing substantially, but evidence for associations between the use of dipeptidyl peptidase-4 inhibitors (DPP-4is), novel incretin-based antidiabetic drugs, and clinical hard endpoints in this group remains inconclusive. We aimed to assess the safety and cardiovascular effects of DPP-4i use in a nationally representative sample of elderly adults with T2D.

      Design, setting, and participants

      We conducted a nationwide, observational, propensity score–matched study using Taiwan's National Health Insurance Research Database. Of a total of 414,213 patients aged ≥65 years with T2D, 58,485 patients receiving initial DPP-4i prescriptions between March 1, 2009, and June 31, 2013, were included. Each DPP-4i user was matched with a nonuser control using propensity scores. The endpoints were all-cause mortality and major adverse cardiovascular events (MACEs), including ischemic stroke and myocardial infarction. Potential adverse effects of hospitalization for heart failure and hypoglycemia were also evaluated.

      Results

      Compared with the matched control cohort, the risks of all-cause mortality (hazard ratio [HR] 0.54, 95% confidence interval [CI] 0.52–0.56), MACEs (HR 0.79, 95% CI 0.75–0.83), myocardial infarction (HR 0.79, 95% CI 0.72–0.87), and ischemic stroke (HR 0.79, 95% CI 0.75–0.84) were lower in the DPP-4i cohort. DPP-4i use did not affect the risks of hospitalization for heart failure and hypoglycemia. Stratified analyses produced consistent results across age, sex, and comorbidity subgroups.

      Conclusions

      Prescription of DPP-4is was associated with reduced risks of all-cause mortality and MACEs in patients aged ≥65 years with T2D.

      Keywords

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