Abstract
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.
Highlights
Atrial fibrillation (AF) is the most common cardiac arrhythmia and significantly increases the risk of comorbidity and mortality [1, 2] with a threefold increased risk of heart failure and a fivefold increased risk of stroke [3,4,5,6]
The dipeptidyl peptidase-4 inhibitor (DPP4i) group had a higher use of statins and angiotensin-converting enzyme inhibitor/angiotensin receptor blockers than non-DPP4i group, while age, gender, comorbidities and other medications were all similar between two study groups at baseline
DPP4i users were associated with a lower risk of new-onset atrial fibrillation (AF) compared with non-DPP4i users, either before or after propensity-score weighting [hazard ratio (HR): 0.65; 95% confidential interval (CI) 0.56– 0.76; P < 0.0001]
Summary
Atrial fibrillation (AF) is the most common cardiac arrhythmia and significantly increases the risk of comorbidity and mortality [1, 2] with a threefold increased risk of heart failure and a fivefold increased risk of stroke [3,4,5,6]. Diabetes was highly associated with the prevalence of metabolic syndrome, which is associated with a higher risk for AF [8]. This study had as its underlying hypothesis that DPP4i could potentially reduce the incidence of AF in type-2 diabetic patients. The goal of the present study was to evaluate the risk of AF associated with use of DPP4i in a nationwide cohort study of diabetic patients in Taiwan. Whether 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
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
