title: Hospitalisation for heart failure and mortality associated with dipeptidyl peptidase 4 (DPP-4) inhibitor use in an unselected population of subjects with type 2 diabetes: a nested case-control study.
abstract: OBJECTIVE
  The SAVOR TIMI-53 study reported a significant increase in the risk of hospitalisation for heart failure (HF) in patients treated with a DPP-4 inhibitor (DPP-4i) in comparison with placebo. A recent case-control study in part confirmed this risk signal. Our aim was to compare the occurrence of HF in relation to DPP-4i use versus any antidiabetic treatment.
  
  
  METHODS
  Population-based matched case-control study conducted using administrative data.
  
  
  METHODS
  The Italian Region of Piedmont (4.4 million inhabitants).
  
  
  METHODS
  From a database of 282,000 patients treated with antidiabetic drugs, we identified 14,613 hospitalisations for HF, 7212 incident cases, and 1727 hospital re-admissions between 2008 and 2012; each case was matched for gender, age and antidiabetic therapy with 10 controls; cases and controls were compared for exposure to DPP-4i.
  
  
  METHODS
  ORs and 95% CIs were calculated by fitting a conditional logistic model. All analyses were adjusted for available risk factors for HF.
  
  
  RESULTS
  We found no increased risk of hospitalisation for HF associated with the use of DPP-4i (OR for admission for HF 1.00 (0.94 to 1.07), incident HF1.01 (0.92 to 1.11), recurrent HF 1.02 (0.84 to 1.22)). All-cause mortality was 6% lower in DPP-4i users (p<0.001), whereas insulin users showed an excess of risk for any type of hospital admission (19%) and death (20%) (p<0.001).
  
  
  CONCLUSIONS
  Our findings suggest that, in an unselected population of diabetic patients, the use of DPP-4i is not associated with an increased risk of HF. The favourable impact on all-cause mortality should be viewed with caution and also other explanations investigated.
authors.affiliation: Metabolism and Diabetes Unit, ASL TO5, Regione Piemonte, Chieri, Italy.
authors.forename: Carlo B
authors.initials: CB
authors.lastname: Giorda
authors.affiliation: Epidemiology Unit, ASL TO3, Regione Piemonte, Grugliasco, Italy.
authors.forename: Roberta
authors.initials: R
authors.lastname: Picariello
authors.affiliation: Chaira Medica Association, Chieri, Italy.
authors.forename: Barbara
authors.initials: B
authors.lastname: Tartaglino
authors.affiliation: Metabolism and Diabetes Unit, ASL TO5, Regione Piemonte, Chieri, Italy.
authors.forename: Lisa
authors.initials: L
authors.lastname: Marafetti
authors.affiliation: Metabolism and Diabetes Unit, ASL TO5, Regione Piemonte, Chieri, Italy.
authors.forename: Fabiana
authors.initials: F
authors.lastname: Di Noi
authors.affiliation: Metabolism and Diabetes Unit, ASL TO5, Regione Piemonte, Chieri, Italy.
authors.forename: Annalisa
authors.initials: A
authors.lastname: Alessiato
authors.affiliation: Epidemiology Unit, ASL TO3, Regione Piemonte, Grugliasco, Italy Department of Clinical and Biological Sciences, University of Torino, Torino, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Costa
authors.affiliation: Epidemiology Unit, ASL TO3, Regione Piemonte, Grugliasco, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Gnavi
mesh_terms: D000368:Aged; D016022:Case-Control Studies; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000401:mortality; D003925:Diabetic Angiopathies / Q000188:drug therapy* / Q000401:mortality / Q000517:prevention & control; D054873:Dipeptidyl-Peptidase IV Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D006333:Heart Failure / Q000188:drug therapy* / Q000401:mortality / Q000517:prevention & control; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D008297:Male; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D054873:Dipeptidyl-Peptidase IV Inhibitors; D007004:Hypoglycemic Agents