IMPACT OF DIPEPTIDYL PEPTIDASE-4 INHIBITORS ON THE RISK OF CARDIOVACULAR-RELATED HOSPITALIZATIONS

Purpose:

To examine the risk of inpatient hospitalization due to cardiovascular events associated with the use of DPP-4 inhibitors, compared to other anti-diabetic agents, among diabetic patients.

Method:

Patients age >18 years and taking diabetes medication were identified in the IMS Lifelink Plus® database for the years 2006-2013. Cardiovascular events were defined as inpatient discharge diagnosis of heart failure, stroke and coronary heart disease occurring at least 30 days after initiation of therapy. Patients were continuously enrolled for 6 months prior and 24 months post the date of first antidiabetic prescription (‘index-date’). Patients with cardiovascular event in 6-month pre-index period were excluded. Patients were followed for 24 months post index-date. Patients with at-least 30 days of DPP-4 inhibitors as their starting therapy were identified as DPP-4 inhibitors users, while patients with at-least 30 days of any other anti-diabetic therapy and no DPP-4 inhibitors in the 24-month follow-up period were identified as other anti-diabetic users. Patients with prescription for only insulin during the follow-up period were excluded. Logistic regression analysis was carried out to access the effect of exposure on the outcome. Adjusted analysis was performed using patient age, sex, geographic region other conditions and comorbidities such as hypertension, insulin use and dyslipidemia as covariates.

Result:

The final sample consisted of 44,209 patients with mean age of 50.71 years and 55.15 % females. Of these, 1973 patients had DPP-4 inhibitors while 42,234 had other anti-diabetic therapy. At baseline 47% patients had hypertension, 29% had dyslipidemia and 28.63% and 8% of the patients were taking insulin. Patients taking DPP-4 inhibitors had an increased risk for having a cardiovascular event as compared with those on other anti-diabetic agents (unadjusted odds ratio:1.557, 95% confidence interval [CI]:1.154-2.101 ; adjusted odds ratio: 1.309, 95% CI: 0.967-1.772).

Conclusion: DPP4 inhibitors may increase the risk of cardiovascular events as compared to other anti-diabetic agents, which warrants close monitoring of diabetic patients on DPP-4 inhibitors.