Cardiovascular events associated with second‐line anti‐diabetes treatments: analysis of real‐world Korean data

May 20, 2017Diabetic medicine : a journal of the British Diabetic Association

Heart problems linked to second-choice diabetes medicines in real-world Korean patients

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Abstract

Among 40,263 individuals with Type 2 diabetes, MET + DPP4i users experienced 744 cardiovascular disease events over 40,374 person-years.

The risk of cardiovascular disease events was lower for MET + DPP4i users compared to MET + SU users, with a hazard ratio of 0.79.
MET + TZD users showed a hazard ratio of 0.85 for cardiovascular disease events when compared to MET + SU users.
For all-cause mortality, MET + DPP4i users had a hazard ratio of 0.84 compared to MET + SU users.
The hazard ratio for all-cause mortality in MET + TZD users compared to MET + SU users was 0.67.

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AIM: To compare the risks of cardiovascular disease (CVD) and all-cause mortality associated with sulfonylurea (SU), dipeptidyl peptidase-4 inhibitor (DPP4i) and thiazolidinedione (TZD) as add-on medications to metformin (MET) therapy in people with Type 2 diabetes.

METHODS: We identified 40 263 individuals who used SU (n = 11 582), DPP4i (n = 26 623) or TZD (n = 2058) in addition to MET between January 2013 and June 2015 from the database of the Korean National Health Insurance, the single-payer healthcare system in South Korea. Cox proportional hazard models were used to estimate hazard ratios for major CVD event (coronary artery disease, heart failure, stroke or transient ischaemic attack) development and all-cause mortality by second-line anti-diabetes medication type. Age, sex, duration of MET monotherapy, calendar year and comorbid conditions were adjusted as potential confounders.

RESULTS: The observed numbers of CVD events (total observed person-time) were 485 (18 778 person-years) for MET + SU, 744 (40 374 person-years) for MET + DPP4i and 60 (3014 person-years) for MET + TZD users. Compared with MET + SU users, the fully adjusted hazard ratios for CVD events were 0.79 [95% confidence interval (CI): 0.71-0.89] for MET + DPP4i users and 0.85 (95% CI: 0.65-1.11) for MET + TZD users. The corresponding hazard ratios for all-cause mortality were 0.84 (95% CI: 0.66-1.07) for MET + DPP4i users and 0.67 (95% CI: 0.35-1.28) for MET + TZD users.

CONCLUSION: Analysis of Korea National Health Insurance database showed that MET + DPP4i treatment for diabetes had a lower CVD risk than MET + SU treatment.

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Cardiovascular events associated with second‐line anti‐diabetes treatments: analysis of real‐world Korean data

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