Abstract
Background
The cardiovascular safety and efficacy of sitagliptin, a dipeptidyl peptidase 4 (DPP-4)
inhibitor, in type 2 diabetic patients with chronic kidney disease (CKD) after acute
myocardial infarction (AMI) are unclear.
Methods
We analyzed data from the Taiwan National Health Insurance Research Database between
March 1st, 2009 and December 31st, 2011. A total of 1025 AMI patients with diabetes
with chronic kidney disease were selected as the study cohort. The study evaluated
the cardiovascular safety and efficacy of sitagliptin by comparing 205 subjects (20%)
who use sitagliptin to 820 matched subjects (80%) who do not. The primary outcomes
included myocardial infarction, ischemic stroke or cardiovascular death.
Results
Primary composite outcomes occurred in 54 patients in the sitagliptin group (26.3%)
and in 164 patients in the comparison group (20.0%) (HR, 1.32; 95% CI, 0.97–1.79;
P = 0.079) during the mean follow-up of 1.02 years (SD = 0.71 years). The sitagliptin group had similar risks of ischemic stroke, all-cause mortality
or hospitalization for heart failure (HF) compared to the non-sitagliptin group (P = 0.938, 0.523 and 0.795 respectively). However, sitagliptin use was associated with
increased risks of recurrent myocardial infarction (HR, 1.73; 95% CI, 1.15–2.58; P = 0.008) and percutaneous coronary revascularization (HR, 1.43; 95% CI, 1.04–1.95; P = 0.026).
Conclusions
Among type 2 diabetic patients with CKD after AMI, the use of sitagliptin was not
associated with an increased risk of cardiovascular death, ischemic stroke or hospitalization
for HF but was associated with increased risks of recurrent MI and percutaneous coronary
revascularization.
Keywords
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Article info
Publication history
Published online: December 03, 2014
Accepted:
December 2,
2014
Received in revised form:
November 30,
2014
Received:
November 6,
2014
Identification
Copyright
© 2014 Elsevier Ireland Ltd. Published by Elsevier Inc. All rights reserved.
