Abstract
BackgroundPrevious studies regarding the cardioprotective effects of dipeptidyl peptidase 4 (DPP-4) inhibitors have not provided sufficient evidence of a relationship between DPP-4 inhibition and actual cardiovascular outcomes. This study aimed to evaluate the impact of DPP-4 inhibitors on the survival of diabetic patients after first acute myocardial infarction (AMI).MethodsThis was a nationwide, propensity score-matched, case–control study of 186,112 first AMI patients, 72,924 of whom had diabetes. A propensity score, one-to-one matching technique was used to match 2672 controls to 2672 patients in the DPP-4 inhibitor group for analysis. Controls were matched based on gender, age, and a history of hypertension, dyslipidemia, diabetes, peripheral vascular disease, heart failure, cerebrovascular accident, end-stage renal disease, chronic obstructive pulmonary disease, and percutaneous coronary intervention.ResultsDPP-4 inhibitors improve the overall 3-year survival rate (log rank P < 0.0001), whether male or female. Cox proportional hazard regression showed DPP-4 inhibitor is beneficial in diabetes patients after AMI (HR = 0.86; 95% CI 0.78–0.95), especially in those patients with hypertension (HR = 0.87; 95% CI 0.78–0.97; P = 0.0103) and cerebrovascular disease (HR = 0.83; 95% CI 0.72–0.97; P = 0.018), but without dyslipidemia (HR = 0.78; 95% CI 0.67–0.92; P = 0.0029), without peripheral vascular disease (HR = 0.86; 95% CI 0.78–0.96; P = 0.0047), without heart failure (HR = 0.84; 95% CI 0.73–0.96; P = 0.0106), without end stage renal disease (HR = 0.86; 95% CI 0.77–0.95; P = 0.0035), and without chronic obstructive pulmonary disease (HR = 0.87; 95% CI 0.78–0.97; P = 0.0096).ConclusionsDPP-4 inhibitor therapy improved long-term survival in diabetic patients after first AMI, regardless of gender.
Highlights
Diabetes mellitus (DM) with hyperglycemia and insulin resistance is one of the main risk factors for cardiovascular disease
This study aimed to evaluate the impact of Dipeptidyl peptidase 4 inhibitors (DPP-4i) on survival of diabetic patients after first acute myocardial infarction (AMI) through analysis of the data from the Taiwan National Health Insurance Research Database
This study demonstrated that use of DPP-4i in acute myo‐ cardial infarction (AMI) patients with diabetes resulted in improved 3-year survival rates
Summary
Diabetes mellitus (DM) with hyperglycemia and insulin resistance is one of the main risk factors for cardiovascular disease. DPP-4 inhibitors were shown to achieve cardioprotective effects via several mechanisms. Double-blind study studies, DPP-4i did not appear to increase the risk of major adverse cardiovascular events among patients with type 2 DM with established cardiovascular disease [8, 9]. DPP-4i were shown to have a neutral effect on rates of major adverse ischemic cardiovascular events and to have increased the rate of hospitalization for heart failure in DM patients with ACS [10, 11]. This study aimed to evaluate the impact of DPP-4 inhibitors on the survival of diabetic patients after first acute myo‐ cardial infarction (AMI)
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