| Abstract: | Objective: While saxagliptin is associated with hospitalization for heart failure (HF), the prognostic impact of Dipeptidyl peptidase-4 inhibitors (DPP4i) in diabetic patients with and without existed HF is yet determined. Methods: The study population, derived from the National Health Insurance Research Database of newly diagnosed type 2 diabetic subjects, comprised 32282 sitagliptin users and 32282 age-, sex, and HF history-matched non-users. Among them, 3680 subjects in each cohort had existed HF (CHF group) and 1203 subjects had been hospitalized for HF within the past year (AHF group) Results: Sitagliptin was clearly associated with higher rate for HF hospitalization in non-HF group, in CHF group and in AHF group. (Figure) With accounting for age, gender, hypertension, CAD, CKD, stroke, COPD, malignancy, and uses of sulfonyurea, bigluanide, α-glicosidase inhibitor, thiazolidinedione and insulin, Sitagliptin independently correlated with HF hospitlizaiton in non-HF group [HR and 95% CI: 1.56 (1.31–1.85)], in CHF group [1.72 (1.30–2.29)], and in AHF group [1.93 (1.59–2.35)]. With propensity score adjusting, sitagliptin remained an independent predictor for HF admission. The impact of DPP4 was increased along the order of non-HF subjects, CHF subjects, and AHF subjects with risk differences of 3, 16.2 and 96.94 per 1000 person-years (p-value for trend <0.001). Conclusions: The associations between sitagliptin and HF hospitalizations were universally present in patients with and without existed HF. Giving HF patients possessed higher HF admission risks than those without HF, cautions should be paid at prescribing DPP4i to patients with recent HF hospitalizations. |
