Dipeptidyl peptidase-4 inhibitors and risk of heart failure in type 2 diabetes: systematic review and meta-analysis of randomised and observational studies

被引：182

作者：

Li, Ling ^{[1
]}

Li, Sheyu ^{[2
]}

Deng, Ke ^{[3
]}

Liu, Jiali ^{[1
]}

Vandvik, Per Olav ^{[4
,5
]}

Zhao, Pujing ^{[1
]}

Zhang, Longhao ^{[1
]}

Shen, Jiantong ^{[1
]}

Bala, Malgorzata M. ^{[6
]}

Sohani, Zahra N. ^{[7
,8
]}

Wong, Evelyn ^{[9
]}

Busse, Jason W. ^{[7
,10
,11
]}

Ebrahim, Shanil ^{[7
,10
,12
,13
]}

Malaga, German ^{[14
]}

Rios, Lorena P. ^{[15
]}

Wang, Yingqiang ^{[16
]}

Chen, Qunfei ^{[17
]}

Guyatt, Gordon H. ^{[7
,18
]}

Sun, Xin ^{[1
]}

机构：

[1] Sichuan Univ, West China Hosp, Chinese Evidence Based Med Ctr, Chengdu 610041, Sichuan, Peoples R China

[2] West China Hosp, Dept Endocrinol & Metab, Chengdu, Peoples R China

[3] Sichuan Univ, West China Sch Pharm, Chengdu 610064, Peoples R China

[4] Norwegian Knowledge Ctr Hlth Serv, Oslo, Norway

[5] Innlandet Hosp Trust, Dept Med, Gjovik, Norway

[6] Jagiellonian Univ, Coll Med, Dept Hyg & Dietet, Krakow, Poland

[7] McMaster Univ, Dept Clin Epidemiol & Biostat, Hamilton, ON, Canada

[8] Univ Toronto, Fac Med, Toronto, ON, Canada

[9] Univ British Columbia, Dept Med, Vancouver, BC V5Z 1M9, Canada

[10] McMaster Univ, Dept Anesthesia, Hamilton, ON, Canada

[11] McMaster Univ, Michael G DeGroote Inst Pain Res & Care, Hamilton, ON, Canada

[12] Stanford Univ, Dept Med, Stanford Prevent Res Ctr, Stanford, CA 94305 USA

[13] Hosp Sick Children, Dept Anaesthesia & Pain Med, 555 Univ Ave, Toronto, ON M5G 1X8, Canada

[14] Univ Peruana Cayetano Heredia, Dept Med, Lima, Peru

[15] Hosp Clin FUSAT, Internal Med Unit, Rancagua, Chile

[16] 363 Hosp, Dept Med Adm, Chengdu, Sichuan, Peoples R China

[17] Lanzhou Univ, Hosp 2, Lanzhou 730000, Gansu, Peoples R China

[18] McMaster Univ, Dept Med, Hamilton, ON, Canada

来源：

BMJ-BRITISH MEDICAL JOURNAL | 2016年 / 352卷

基金：

加拿大健康研究院; 中国国家自然科学基金;

关键词：

IMPROVES GLYCEMIC CONTROL; INITIAL COMBINATION THERAPY; DRUG-NAIVE PATIENTS; PLACEBO-CONTROLLED TRIAL; ADD-ON THERAPY; DOUBLE-BLIND; CARDIOVASCULAR OUTCOMES; JAPANESE PATIENTS; METFORMIN MONOTHERAPY; RENAL IMPAIRMENT;

D O I：

10.1136/bmj.i610

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

OBJECTIVES To examine the association between dipeptidyl peptidase-4 (DPP-4) inhibitors and the risk of heart failure or hospital admission for heart failure in patients with type 2 diabetes. DESIGN Systematic review and meta-analysis of randomised and observational studies. DATA SOURCES Medline, Embase, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov searched up to 25 June 2015, and communication with experts. ELIGIBILITY CRITERIA Randomised controlled trials, non-randomised controlled trials, cohort studies, and case-control studies that compared DPP-4 inhibitors against placebo, lifestyle modification, or active antidiabetic drugs in adults with type 2 diabetes, and explicitly reported the outcome of heart failure or hospital admission for heart failure. DATA COLLECTION AND ANALYSIS Teams of paired reviewers independently screened for eligible studies, assessed risk of bias, and extracted data using standardised, pilot tested forms. Data from trials and observational studies were pooled separately; quality of evidence was assessed by the GRADE approach. RESULTS Eligible studies included 43 trials (n= 68 775) and 12 observational studies (nine cohort studies, three nested case-control studies; n= 1 777 358). Pooling of 38 trials reporting heart failure provided low quality evidence for a possible similar risk of heart failure between DPP-4 inhibitor use versus control (42/15 701 v 33/12 591; odds ratio 0.97 (95% confidence interval 0.61 to 1.56); risk difference 2 fewer (19 fewer to 28 more) events per 1000 patients with type 2 diabetes over five years). The observational studies provided effect estimates generally consistent with trial findings, but with very low quality evidence. Pooling of the five trials reporting admission for heart failure provided moderate quality evidence for an increased risk in patients treated with DPP-4 inhibitors versus control (622/18 554 v 552/ 18 474; 1.13 (1.00 to 1.26); 8 more (0 more to 16 more)). The pooling of adjusted estimates from observational studies similarly suggested (with very low quality evidence) a possible increased risk of admission for heart failure (adjusted odds ratio 1.41, 95% confidence interval 0.95 to 2.09) in patients treated with DPP-4 inhibitors (exclusively sitagliptin) versus no use. CONCLUSIONS The relative effect of DPP-4 inhibitors on the risk of heart failure in patients with type 2 diabetes is uncertain, given the relatively short follow-up and low quality of evidence. Both randomised controlled trials and observational studies, however, suggest that these drugs may increase the risk of hospital admission for heart failure in those patients with existing cardiovascular diseases or multiple risk factors for vascular diseases, compared with no use.

引用

页数：17

共 111 条

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