PMID- 26888822
OWN - NLM
STAT- MEDLINE
DCOM- 20160616
LR  - 20171030
IS  - 1756-1833 (Electronic)
IS  - 0959-8138 (Linking)
VI  - 352
DP  - 2016 Feb 17
TI  - Dipeptidyl peptidase-4 inhibitors and risk of heart failure in type 2 diabetes:
      systematic review and meta-analysis of randomised and observational studies.
PG  - i610
LID - 10.1136/bmj.i610 [doi]
AB  - 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.
CI  - Published by the BMJ Publishing Group Limited. For permission to use (where not
      already granted under a licence) please go to
      http://group.bmj.com/group/rights-licensing/permissions.
FAU - Li, Ling
AU  - Li L
AD  - Chinese Evidence-based Medicine Centre, West China Hospital, Sichuan University, 
      Chengdu 610041, Sichuan, China.
FAU - Li, Sheyu
AU  - Li S
AD  - Department of Endocrinology and Metabolism, West China Hospita, Chengdu.
FAU - Deng, Ke
AU  - Deng K
AD  - West China School of Pharmacy, Sichuan University, Chengdu.
FAU - Liu, Jiali
AU  - Liu J
AD  - Chinese Evidence-based Medicine Centre, West China Hospital, Sichuan University, 
      Chengdu 610041, Sichuan, China.
FAU - Vandvik, Per Olav
AU  - Vandvik PO
AD  - Norwegian Knowledge Centre for the Health Services, Oslo, Norway Department of
      Medicine, Innlandet Hospital Trust, Gjovik, Norway.
FAU - Zhao, Pujing
AU  - Zhao P
AD  - Chinese Evidence-based Medicine Centre, West China Hospital, Sichuan University, 
      Chengdu 610041, Sichuan, China.
FAU - Zhang, Longhao
AU  - Zhang L
AD  - Chinese Evidence-based Medicine Centre, West China Hospital, Sichuan University, 
      Chengdu 610041, Sichuan, China.
FAU - Shen, Jiantong
AU  - Shen J
AD  - Chinese Evidence-based Medicine Centre, West China Hospital, Sichuan University, 
      Chengdu 610041, Sichuan, China.
FAU - Bala, Malgorzata M
AU  - Bala MM
AD  - Department of Hygiene and Dietetics, Jagiellonian University Medical College,
      Krakow, Poland.
FAU - Sohani, Zahra N
AU  - Sohani ZN
AD  - Department of Clinical Epidemiology and Biostatistics, McMaster University,
      Hamilton, ON Canada Faculty of Medicine, University of Toronto, Toronto, ON,
      Canada.
FAU - Wong, Evelyn
AU  - Wong E
AD  - Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
FAU - Busse, Jason W
AU  - Busse JW
AD  - Department of Clinical Epidemiology and Biostatistics, McMaster University,
      Hamilton, ON Canada Department of Anesthesia, McMaster University, Hamilton
      Michael G DeGroote Institute for Pain Research and Care, McMaster University,
      Hamilton.
FAU - Ebrahim, Shanil
AU  - Ebrahim S
AD  - Department of Clinical Epidemiology and Biostatistics, McMaster University,
      Hamilton, ON Canada Department of Anesthesia, McMaster University, Hamilton
      Stanford Prevention Research Center, Department of Medicine, Stanford University,
      Stanford, CA, USA Department of Anaesthesia and Pain Medicine, Hospital for Sick 
      Children, Toronto, ON Canada.
FAU - Malaga, German
AU  - Malaga G
AD  - Department of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru.
FAU - Rios, Lorena P
AU  - Rios LP
AD  - Internal Medicine Unit, Hospital Clinico FUSAT, Rancagua, Chile.
FAU - Wang, Yingqiang
AU  - Wang Y
AD  - Department of Medical Administration, 363 Hospital, Chengdu, Sichuan, China.
FAU - Chen, Qunfei
AU  - Chen Q
AD  - Second Hospital of Lanzhou University, Lanzhou, Gansu, China.
FAU - Guyatt, Gordon H
AU  - Guyatt GH
AD  - Department of Clinical Epidemiology and Biostatistics, McMaster University,
      Hamilton, ON Canada Department of Medicine, McMaster University, Hamilton.
FAU - Sun, Xin
AU  - Sun X
AD  - Chinese Evidence-based Medicine Centre, West China Hospital, Sichuan University, 
      Chengdu 610041, Sichuan, China sunx26@gmail.com.
LA  - eng
GR  - Canadian Institutes of Health Research/Canada
PT  - Journal Article
PT  - Meta-Analysis
PT  - Research Support, Non-U.S. Gov't
PT  - Review
DEP - 20160217
PL  - England
TA  - BMJ
JT  - BMJ (Clinical research ed.)
JID - 8900488
RN  - 0 (Dipeptidyl-Peptidase IV Inhibitors)
RN  - 0 (Hypoglycemic Agents)
SB  - AIM
SB  - IM
CIN - BMJ. 2016;352:i801. PMID: 26888024
CIN - BMJ. 2016 May 24;353:i2927. PMID: 27220956
MH  - Cardiovascular Diseases/complications
MH  - Diabetes Mellitus, Type 2/*drug therapy
MH  - Dipeptidyl-Peptidase IV Inhibitors/*adverse effects/therapeutic use
MH  - Heart Failure/*chemically induced
MH  - Hospitalization/statistics & numerical data
MH  - Humans
MH  - Hypoglycemic Agents/*adverse effects/therapeutic use
MH  - Observational Studies as Topic
MH  - Odds Ratio
MH  - Randomized Controlled Trials as Topic
MH  - Risk Factors
PMC - PMC4772781
EDAT- 2016/02/19 06:00
MHDA- 2016/06/17 06:00
CRDT- 2016/02/19 06:00
PHST- 2016/02/19 06:00 [entrez]
PHST- 2016/02/19 06:00 [pubmed]
PHST- 2016/06/17 06:00 [medline]
PST - epublish
SO  - BMJ. 2016 Feb 17;352:i610.