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Dipeptidyl peptidase-4 inhibitors and heart failure: a meta-analysis of randomized clinical trials

M Monami1, I Dicembrini2, E Mannucci3

  • 1Section of Geriatric and Medicine, Careggi Teaching Hospital, Via delle Oblate 4, 50141 Florence, Italy.

Nutrition, Metabolism, and Cardiovascular Diseases : NMCD
|May 6, 2014
PubMed

Insights

Dipeptidyl peptidase-4 inhibitors (DPP4i) may increase the risk of heart failure hospitalizations in patients with type 2 diabetes. This meta-analysis found a higher overall risk of acute heart failure with DPP4i compared to placebo or active drugs.

Area of Science:

  • Cardiology
  • Endocrinology
  • Pharmacology

Background:

  • Recent SAVOR TIMI-53 trial indicated increased heart failure risk with saxagliptin.
  • Dipeptidyl peptidase-4 inhibitors (DPP4i) are commonly used for type 2 diabetes management.

Purpose of the Study:

  • To systematically analyze randomized clinical trials (RCTs) for treatment-emergent acute heart failure in patients using DPP4 inhibitors.
  • To synthesize evidence on the association between DPP4 inhibitors and heart failure risk.

Main Methods:

  • Comprehensive literature search of Medline, Embase, and Cochrane databases up to October 2013.
  • Inclusion of 84 randomized clinical trials (≥24 weeks) comparing DPP4 inhibitors with placebo or active drugs in type 2 diabetes patients.
  • Primary outcome assessed was the incidence of acute heart failure.

Main Results:

  • The overall risk of acute heart failure was significantly higher in patients treated with DPP4 inhibitors compared to placebo/active comparators (MH-OR: 1.19 [1.03; 1.37]; p = 0.015).
  • Analysis of trials focusing on non-cardiovascular outcomes did not reveal an increased risk signal.
  • No clear differences in heart failure risk were observed among different DPP4 inhibitor drugs.

Conclusions:

  • Available RCT data suggest a potential association between DPP4 inhibitors and an increased risk of heart failure.
  • Current evidence is insufficient to identify specific patient subpopulations at higher risk.
  • Further research is needed to clarify risks in susceptible patient groups.
Abstract

Keywords:
DPP-4 inhibitorsHeart failureMeta-analysis

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