Incretin-based drugs and the risk of heart failure (Q13-40)

Incretin-based drugs and the risk of heart failure (Q13-40)

Q13-40

Overview

What is the issue?
  • Incretin-based drugs are medications prescribed to lower blood sugar levels in patients with type 2 diabetes. However, there is concern that they may increase the risk of heart failure.
What was the aim of the study?
  • This study aimed to compare the risk of hospitalization for heart failure among patients with type 2 diabetes using incretin-based drugs to that in patients using combinations of other oral antidiabetic drugs.
How was the study conducted?
  • Our investigators conducted six cohort studies with the health records of over 1.4 million patients with type 2 diabetes from four Canadian provinces and two international databases.
  • Investigators identified all patients, at least 18 years of age, with a first prescription for a non-insulin antidiabetic drug. These patients were separated into two groups: those with a history of heart failure and those without a history of heart failure.
  • Nested case-control analyses were performed in each group to compare the incidence of hospitalization for heart failure in those receiving incretin-based drugs to that in patients receiving combinations of other oral antidiabetic drugs. Results were then pooled across sites via meta-analysis.
What did the study find?
  • We have the ability to analyze a large amount of anonymous patient data to reliably address questions about drug safety and effectiveness. The cohorts in this study included 1,499,650 patients, with 29,741 hospitalized for heart failure (incidence rate: 9.2 per 1,000 per year).
  • This study found that patients using incretin-based drugs do not have a higher risk of hospitalization for heart failure compared with patients using combinations of other oral antidiabetic drugs. This was true for patients with and without a history of heart failure.
Implications
  • Our study provides some reassurance that using incretin-based drugs will not put patients at a higher risk of heart failure. But medication choice needs to be a decision between physician and patient, taking medical history and other factors into account.
Key message
  • Patients with type 2 diabetes using incretin-based drugs to lower their blood sugar levels do not have an increased risk of heart failure, compared to those using combinations of other oral antidiabetic drugs.

Manuscripts

Secrest M, Udell JA, Filion KB. The cardiovascular safety trials of DPP-4 inhibitors, GLP-1 agonists, and SGLT2 inhibitors. Trends Cardiovasc Med 2017 Apr;27(3):194-202.

Filion KB, Suissa S. DPP-4 inhibitors and heart failure: Some reassurance, some uncertainty. Diabetes Care 2016 May; 39(5):735–737. [Invited Commentary].

Azoulay L, Filion B, Platt R, Dahl M, Dormuth C, Clemens K, Durand M, Hu N, Juurlink D, Paterson M, Targownik L, Turin T, Ernst P, CNODES Investigators. Association Between Incretin-Based Drugs and the Risk of Acute Pancreatitis. JAMA Intern Med. 2016 Oct 1;176(10):1464-1473.

Azoulay L, Filion KB, Platt R, Dahl M, Dormuth C, Clemens K, Durand M, Juurlink DN, Targownik L, Turin T, Paterson M, Ernst P; CNODES Investigators. Incretin based drugs and the risk of pancreatic cancer: international multicentre cohort study. BMJ. 2016 Feb 17;352:i581.

Filion KB, Azoulay L, Platt R, Dahl M, Dormuth C, Clemens K, Hu N, Paterson M, Targownik L, Turin T, Udell J, Ernst P; CNODES Investigators. A Multicenter Observational Study of Incretin-based Drugs and Heart Failure. N Engl J Med. 2016 Mar 24;374(12):1145-54.

Presentations

Project Team

Project Co-Lead
Kristian Filion PhD
Project Co-Lead
Pierre Ernst MD, MSc, FRCPC
Methods Lead
Robert W. Platt PhD
Content Expert
Kristin Clemens
Lead Analyst
Matthew Dahl BSc
Site Investigator
Nianping Hu PhD
Saskatchewan
Site Investigator
Michael Paterson MSc
Ontario
Site Investigator
Jacob Udell
Ontario
Site Investigator
Colin R. Dormuth ScD
MarketScan
Site Investigator
Laurent Azoulay PhD
CPRD
Site Investigator
Tanvir Chowdhury Turin PhD
Alberta
Site Investigator
Laura Targownik
Manitoba
Analyst
Shan Jin MSc
Saskatchewan
Analyst
Fangyun Wu MSc
Ontario
Analyst
Simon Hollands MSc
Ontario
Analyst
Greg Carney BSc, PhD
MarketScan
Analyst
Matthew Dahl BSc
Manitoba
Analyst
Hui Yin MsC
CPRD
Analyst
Zhihai Ma
Alberta
Analyst
Jianguo (James) Zhang MSc
Alberta