Dipeptidyl peptidase-4 inhibitor decreases the risk of atrial fibrillation in patients with type 2 diabetes: a nationwide cohort study in Taiwan

Cardiovascular Diabetology

Original Investigation

Chia-Yu Chang¹  Yung-Hsin Yeh²  Shang-Hung Chang²  Hsin-Fu Lee²  Chi-Tai Kuo²  Lung-Sheng Wu²  Kun-Chi Yen²  Yi-Hsin Chan³  Jia-Rou Liu⁴  Lai-Chu See⁵ 

[1] College of Medicine, Chang Gung University, 33302, Taoyuan, Taiwan;College of Medicine, Chang Gung University, 33302, Taoyuan, Taiwan;Department of Cardiology, Chang Gung Memorial Hospital, Linkou, 33305, Taoyuan, Taiwan;College of Medicine, Chang Gung University, 33302, Taoyuan, Taiwan;Department of Cardiology, Chang Gung Memorial Hospital, Linkou, 33305, Taoyuan, Taiwan;Microscopy Core Laboratory, Chang Gung Memorial Hospital, Linkou, 33305, Taoyuan, Taiwan;Department of Public Health, College of Medicine, Chang Gung University, No. 259, Wenhua 1st Rd., Guishan, 33302, Taoyuan, Taiwan;Biostatistics Core Laboratory, Molecular Medicine Research Center, Chang Gung University, 33302, Taoyuan, Taiwan;Department of Public Health, College of Medicine, Chang Gung University, No. 259, Wenhua 1st Rd., Guishan, 33302, Taoyuan, Taiwan;Biostatistics Core Laboratory, Molecular Medicine Research Center, Chang Gung University, 33302, Taoyuan, Taiwan;Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, Linkou, 33305, Taoyuan, Taiwan;

关键词: Dipeptidyl peptidase-4 inhibitor;    Type 2 diabetes mellitus;    Atrial fibrillation;   

DOI  :  10.1186/s12933-017-0640-5

 received in 2017-09-01, accepted in 2017-12-06,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundWhether dipeptidyl peptidase-4 inhibitor (DPP4i) is associated with a lower risk of new-onset atrial fibrillation (AF) in patients with diabetes remains unclear. This study aimed to evaluate the risk of AF associated with use of DPP4i among a longitudinal cohort of patients with diabetes.MethodsOver a 3-year period, 480,000 patients with diabetes were analyzed utilizing Taiwan’s National Health Insurance Research Database and 90,880 patients taking metformin as first-line therapy were enrolled. Patients were further divided into two groups: (1) DPP4i users: those taking DPP4i and (2) non-DPP4i users: those prescribed other hypoglycemic agents (HAs) as second-line drug. Study end point was defined by diagnosis of AF, addition of any third-line HA, or the end of the study period (December 31, 2013), whichever came first.ResultsA total of 16,017 DPP4i users and 74,863 non-DPP4i users were eligible for the study. For the DPP4i group, most patients were prescribed sitagliptin (n = 12,180; 76%). Among the non-DPP4i group, most patients took sulfonylurea (n = 60,606; 81%) as their second-line medication. DPP4i users were associated with a lower risk of new-onset AF compared with non-DPP4i users after propensity-score weighting (hazard ratio 0.65; P < 0.0001). Subgroup analysis showed that DPP4i user were associated with a lower risk of new-onset AF compared with non-DPP4i users in most subgroups. Multivariate analysis indicated that use of DPP4i was associated with lower risk of new-onset AF and age > 65 years, presence of hypertension, and ischemic heart disease were independent risk factors for new-onset AF.ConclusionsAmong patients with diabetes prescribed with metformin, the patients with DPP4i as second HA were associated with a lower risk of AF compared with the patients with other drugs as second HAs in real-world practice.

【 授权许可】

CC BY   
© The Author(s) 2017