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July 16, 2014
Sitagliptin Increases Hospitalization Risk in Heart Failure Patients With Diabetes
Edmonton, Alberta—Heart failure patients who take sitagliptin for type 2 diabetes increase their risk of hospitalization for their heart condition but not death or all-cause hospital admissions. That’s according to a study published online recently by the journal JACC Heart Failure. Noting that the current literature is unclear on whether dipeptidyl peptidase (DPP)-4 inhibitors cause harm in patients with heart failure (HF) and type 2 diabetes (T2D), researchers from the University of Alberta in Canada analyzed data from a national commercially insured claims database in the United States. For the study, patients with incident HF were identified from a group with T2D initially treated with metformin or sulfonylurea and followed over time. The researchers then compared subjects—58% male, averaging 54-years-old—who subsequently used sitagliptin to those who did not use sitagliptin in the 90 days before the primary outcome of all-cause hospital admission or death. The study also assessed HF-specific hospital admission or death. With 7,620 patients with diabetes and incident HF meeting the inclusion criteria, 887 patients (12%) were on sitagliptin therapy, representing 521 patient years of exposure, after HF diagnosis. Slightly more than half, 54%, of the larger group met a primary endpoint during the study period. Results indicate that sitagliptin users were not at an increased risk for the primary endpoint (7.1% vs. 9.2%, adjusted odds ratio [aOR]: 0.84, 95% confidence interval [CI]: 0.69 to 1.03) or each component (hospital admission 7.5% vs. 9.2%, aOR: 0.93, 95% CI: 0.76 to 1.14; death 6.9% vs. 9.3%, aOR: 1.16, 95% CI: 0.68 to 1.97). The DPP-4 was associated, however, with an increased risk of HF hospitalizations (12.5% vs. 9.0%, aOR: 1.84, 95% CI: 1.16 to 2.92). In an associated commentary, Deepak L. Bhatt, MD, MPH and Matthew A. Cavender, MD, MPH, of the Thrombolysis in Myocardial Infarction Study Group at Brigham and Women’s Hospital state that this was the latest in a growing list of diabetes medications associated with poor outcomes in heart failure. Bhatt and Cavender point out that, while an association has been observed, “The mechanism is undefined, and it remains unclear whether this association is related to concomitant medical problems associated with diabetes (e.g., ischemic heart disease, renal dysfunction, and hypertension) or the direct effect of poorly controlled blood glucose.” They also note that current American Diabetes Association guidelines recommend that commonly used antihyperglycemic agents, such as thiazolidinedione agents, should be used with caution in patients with heart failure. “The finding that sitagliptin is associated with hospitalization due to heart failure adds to the known association of other diabetes medications with heart failure,” according to the commentary. “For example, fluid retention may occur in patients treated with thiazolidinedione medications. Findings recently reported have described a possible increase in the risk of heart failure with various anti-hyperglycemic agents (including other DPP-IV inhibitors).”
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