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

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dc.contributor.author Li, Ling
dc.contributor.author Li, Sheyu
dc.contributor.author Deng, Ke
dc.contributor.author Liu, Jiali
dc.contributor.author Vandvik, Per-Olav
dc.contributor.author Zhao, Pujing
dc.contributor.author Zhang, Longhao
dc.contributor.author Shen, Jiantong
dc.contributor.author Bala, Malgorzata-M.
dc.contributor.author Sohani, Zahra-N.
dc.contributor.author Wong, Evelyn
dc.contributor.author Busse, Jason-W.
dc.contributor.author Ebrahim, Shanil
dc.contributor.author Málaga Rodríguez, Germán Javier
dc.contributor.author Rios, Lorena-P.
dc.contributor.author Wang, Yingqiang
dc.contributor.author Chen, Qunfei
dc.contributor.author Guyatt, Gordon-H.
dc.contributor.author Sun, Xin
dc.date.accessioned 2019-02-06T14:45:36Z
dc.date.available 2019-02-06T14:45:36Z
dc.date.issued 2016
dc.identifier.uri https://hdl.handle.net/20.500.12866/5100
dc.description.abstract 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. en_US
dc.language.iso eng
dc.publisher BMJ Publishing Group
dc.relation.ispartofseries BMJ
dc.rights info:eu-repo/semantics/restrictedAccess
dc.rights.uri https://creativecommons.org/licenses/by-nc-nd/4.0/deed.es
dc.subject Cardiovascular Diseases/complications en_US
dc.subject Diabetes Mellitus, Type 2/drug therapy en_US
dc.subject Dipeptidyl-Peptidase IV Inhibitors/adverse effects/therapeutic use en_US
dc.subject Heart Failure/chemically induced en_US
dc.subject Hospitalization/statistics & numerical data en_US
dc.subject Humans en_US
dc.subject Hypoglycemic Agents/adverse effects/therapeutic use en_US
dc.subject Observational Studies as Topic en_US
dc.subject Odds Ratio en_US
dc.subject Randomized Controlled Trials as Topic en_US
dc.subject Risk Factors en_US
dc.title Dipeptidyl peptidase-4 inhibitors and risk of heart failure in type 2 diabetes: systematic review and meta-analysis of randomised and observational studies en_US
dc.type info:eu-repo/semantics/article
dc.identifier.doi https://doi.org/10.1136/bmj.i610
dc.subject.ocde https://purl.org/pe-repo/ocde/ford#3.02.00
dc.relation.issn 1756-1833

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