title: Association of antidiabetic medications targeting the glucagon-like peptide 1 pathway and heart failure events in patients with diabetes.
abstract: BACKGROUND
  Glucagon-like peptide-1 (GLP-1) agonists and dipeptidyl peptidase 4 (DPP-4) inhibitors (GLP-1 agents) may be protective in heart failure (HF). We set out to determine whether GLP-1 agent use is associated with HF risk in diabetics.
  
  
  RESULTS
  In this retrospective cohort study of members of a large health system, we identified >19,000 adult diabetics from January 1, 2000, to July 1, 2012. GLP-1 agent users were matched 1:2 to control subjects with the use of propensity matching based on age, race, sex, coronary disease, HF, diabetes duration, and number of antidiabetic medications. The association of GLP-1 agents with time to HF hospitalization was tested with multivariable Cox regression. All-cause hospitalization and mortality were secondary end points. We identified 1,426 users of GLP-1 agents and 2,798 control subjects. Both were similar except for angiotensin-converting enzyme inhibitors/angiotensin receptor blocker use, number of antidiabetic medications, and age. There were 199 hospitalizations, of which 128 were for HF, and 114 deaths. GLP-1 agents were associated with reduced risk of HF hospitalization (adjusted hazard ratio [aHR] 0.51, 95% confidence interval [CI] 0.34-0.77; P = .002), all-cause hospitalization (aHR 0.54, 95% CI 0.38-0.74; P = .001), and death (aHR 0.31, 95% CI 0.18-0.53; P = .001).
  
  
  CONCLUSIONS
  GLP-1 agents may reduce the risk of HF events in diabetics.
authors.affiliation: Department of Internal Medicine, Henry Ford Health System, Detroit, Michigan.
authors.forename: Mauricio
authors.initials: M
authors.lastname: Velez
authors.affiliation: Department of Public Health Sciences, Henry Ford Health System, Detroit, Michigan.
authors.forename: Edward L
authors.initials: EL
authors.lastname: Peterson
authors.affiliation: Department of Public Health Sciences, Henry Ford Health System, Detroit, Michigan.
authors.forename: Karen
authors.initials: K
authors.lastname: Wells
authors.affiliation: Department of Internal Medicine, Henry Ford Health System, Detroit, Michigan.
authors.forename: Tanmay
authors.initials: T
authors.lastname: Swadia
authors.affiliation: Department of Internal Medicine, Henry Ford Health System, Detroit, Michigan.
authors.forename: Hani N
authors.initials: HN
authors.lastname: Sabbah
authors.affiliation: Department of Internal Medicine, Henry Ford Health System, Detroit, Michigan; Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, Michigan.
authors.forename: L Keoki
authors.initials: LK
authors.lastname: Williams
authors.affiliation: Department of Internal Medicine, Henry Ford Health System, Detroit, Michigan; Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, Michigan. Electronic address: dlanfea1@hfhs.org.
authors.forename: David E
authors.initials: DE
authors.lastname: Lanfear
mesh_terms: D000368:Aged; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis / Q000188:drug therapy* / Q000378:metabolism; D054873:Dipeptidyl-Peptidase IV Inhibitors / Q000008:administration & dosage; D016503:Drug Delivery Systems / Q000379:methods*; D005260:Female; D052216:Glucagon-Like Peptide 1 / Q000819:agonists* / Q000378:metabolism; D006333:Heart Failure / Q000175:diagnosis / Q000188:drug therapy* / Q000378:metabolism; D006760:Hospitalization / Q000639:trends; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
chemical_list: D054873:Dipeptidyl-Peptidase IV Inhibitors; D007004:Hypoglycemic Agents; D052216:Glucagon-Like Peptide 1
keywords: DPP-4 inhibitor; GLP-1 agonist; heart failure; outcomes