PMID- 32998736
OWN - NLM
STAT- MEDLINE
DCOM- 20210517
LR  - 20221207
IS  - 1475-2840 (Electronic)
IS  - 1475-2840 (Linking)
VI  - 19
IP  - 1
DP  - 2020 Sep 30
TI  - Major adverse cardiovascular and limb events in patients with diabetes and 
      concomitant peripheral artery disease treated with sodium glucose cotransporter 2 
      inhibitor versus dipeptidyl peptidase-4 inhibitor.
PG  - 160
LID - 10.1186/s12933-020-01118-0 [doi]
LID - 160
AB  - BACKGROUND: Whether sodium glucose co-transporter 2 inhibitors (SGLT2i) are 
      associated with a lower risk of cardiovascular as well as adverse lower limb 
      events in patients with type-2 diabetes mellitus (T2DM) and concomitant 
      peripheral artery disease (PAD) is unclear. We aimed to evaluate the risk of 
      cardiovascular and limb events, and death associated with the use of SGLT2i 
      compared with dipeptidyl peptidase-4 inhibitors (DPP4i) among a longitudinal and 
      national cohort of patients with T2DM. METHODS: In this nationwide retrospective 
      cohort study based on the Taiwan National Health Insurance Research Database, we 
      identified a total of 11,431 and 93,972 consecutive T2DM patients with PAD taking 
      SGLT2i and DPP4i, respectively, from May 1, 2016, to December 31, 2017. We used 
      1:1 propensity score matching (PSM) to balance covariates across study groups. 
      Patients were followed from the drug index date until the occurrence of clinical 
      outcomes, death, discontinuation of the index drug, or the end of the study 
      period, whichever occurred first. RESULTS: Overall, 56% and 44% of the patients 
      were treated with dapagliflozin and empagliflozin, respectively. The use of 
      SGLT2i had comparable risks of ischemic stroke and acute myocardial infarction, 
      and was associated with lower risks of congestive heart failure (CHF) [hazard 
      ratio (HR): 0.66; 95% confidence interval (CI) 0.49-0.89; p = 0.0062], lower limb 
      ischemia requiring revascularization (HR: 0.73; 95% CI 0.54-0.98; p = 0.0367) or 
      amputation (HR: 0.43; 95% CI 0.30-0.62; p < 0.0001), and cardiovascular death 
      (HR: 0.67; 95% CI 0.49-0.90; p = 0.0089) when compared with the DDP4i group after 
      PSM. The subgroup analysis revealed consistent results for CHF and major adverse 
      limb outcomes for SGLT2i versus DPP4i among patients aged >/= 75 years, the 
      presence of chronic kidney disease and established cardiovascular disease was 
      consistent with the main analysis. CONCLUSIONS: SGLT2i were associated with lower 
      risks of CHF and adverse lower limb events compared with DPP4i among patients 
      with T2DM and PAD in real-world practice.
FAU - Lee, Hsin-Fu
AU  - Lee HF
AD  - The Cardiovascular Department, Chang Gung Memorial Hospital, Linkou, Taoyuan, 
      33305, Taiwan.
AD  - College of Medicine, Chang Gung University, Taoyuan, 33302, Taiwan.
AD  - Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung 
      University, Taoyuan, Taiwan.
AD  - Division of Cardiology, Department of Internal Medicine, New Taipei City 
      Municipal Tucheng Hospital (Chang Gung Memorial Hospital, Tucheng branch, 
      Taiwan), Taoyuan, Taiwan.
FAU - Chen, Shao-Wei
AU  - Chen SW
AD  - Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Linkou 
      Medical Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 
      City, Taiwan.
FAU - Liu, Jia-Rou
AU  - Liu JR
AD  - Department of Public Health, College of Medicine, Chang Gung University, No. 259, 
      Wenhua 1st Rd., Guishan Dist, Taoyuan, 33302, Taiwan.
FAU - Li, Pei-Ru
AU  - Li PR
AD  - Department of Public Health, College of Medicine, Chang Gung University, No. 259, 
      Wenhua 1st Rd., Guishan Dist, Taoyuan, 33302, Taiwan.
FAU - Wu, Lung-Sheng
AU  - Wu LS
AD  - The Cardiovascular Department, Chang Gung Memorial Hospital, Linkou, Taoyuan, 
      33305, Taiwan.
AD  - College of Medicine, Chang Gung University, Taoyuan, 33302, Taiwan.
FAU - Chang, Shang-Hung
AU  - Chang SH
AD  - The Cardiovascular Department, Chang Gung Memorial Hospital, Linkou, Taoyuan, 
      33305, Taiwan.
AD  - College of Medicine, Chang Gung University, Taoyuan, 33302, Taiwan.
AD  - Center for Big Data Analytics and Statistics, Chang Gung Memorial Hospital, 
      Taoyuan, Taiwan.
FAU - Yeh, Yung-Hsin
AU  - Yeh YH
AD  - The Cardiovascular Department, Chang Gung Memorial Hospital, Linkou, Taoyuan, 
      33305, Taiwan.
AD  - College of Medicine, Chang Gung University, Taoyuan, 33302, Taiwan.
FAU - Kuo, Chi-Tai
AU  - Kuo CT
AD  - The Cardiovascular Department, Chang Gung Memorial Hospital, Linkou, Taoyuan, 
      33305, Taiwan.
AD  - College of Medicine, Chang Gung University, Taoyuan, 33302, Taiwan.
FAU - Chan, Yi-Hsin
AU  - Chan YH
AD  - The Cardiovascular Department, Chang Gung Memorial Hospital, Linkou, Taoyuan, 
      33305, Taiwan. s851047@hotmail.com.
AD  - College of Medicine, Chang Gung University, Taoyuan, 33302, Taiwan. 
      s851047@hotmail.com.
AD  - Microscopy Core Laboratory, Chang Gung Memorial Hospital, Linkou, Taoyuan, 33305, 
      Taiwan. s851047@hotmail.com.
FAU - See, Lai-Chu
AU  - See LC
AD  - Department of Public Health, College of Medicine, Chang Gung University, No. 259, 
      Wenhua 1st Rd., Guishan Dist, Taoyuan, 33302, Taiwan. lichu@mail.cgu.edu.tw.
AD  - Biostatistics Core Laboratory, Molecular Medicine Research Center, Chang Gung 
      University, Taoyuan, 33302, Taiwan. lichu@mail.cgu.edu.tw.
AD  - Division of Rheumatology, Allergy and Immunology, Department of Internal 
      Medicine, Chang Gung Memorial Hospital, Linkou, Taoyuan, 33305, Taiwan. 
      lichu@mail.cgu.edu.tw.
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20200930
PL  - England
TA  - Cardiovasc Diabetol
JT  - Cardiovascular diabetology
JID - 101147637
RN  - 0 (Dipeptidyl-Peptidase IV Inhibitors)
RN  - 0 (Sodium-Glucose Transporter 2 Inhibitors)
SB  - IM
MH  - Aged
MH  - Aged, 80 and over
MH  - Amputation, Surgical
MH  - Diabetes Mellitus, Type 2/diagnosis/*drug therapy/mortality
MH  - Dipeptidyl-Peptidase IV Inhibitors/adverse effects/*therapeutic use
MH  - Female
MH  - Heart Failure/mortality/prevention & control
MH  - Humans
MH  - Incidence
MH  - Limb Salvage
MH  - Male
MH  - Middle Aged
MH  - Peripheral Arterial Disease/diagnosis/mortality/*therapy
MH  - Retrospective Studies
MH  - Risk Assessment
MH  - Risk Factors
MH  - Sodium-Glucose Transporter 2 Inhibitors/adverse effects/*therapeutic use
MH  - Taiwan/epidemiology
MH  - Time Factors
MH  - Treatment Outcome
PMC - PMC7528264
COIS- The authors declare that they have no competing interests.
EDAT- 2020/10/02 06:00
MHDA- 2021/05/18 06:00
PMCR- 2020/09/30
CRDT- 2020/10/01 05:26
PHST- 2020/07/02 00:00 [received]
PHST- 2020/09/12 00:00 [accepted]
PHST- 2020/10/01 05:26 [entrez]
PHST- 2020/10/02 06:00 [pubmed]
PHST- 2021/05/18 06:00 [medline]
PHST- 2020/09/30 00:00 [pmc-release]
AID - 10.1186/s12933-020-01118-0 [pii]
AID - 1118 [pii]
AID - 10.1186/s12933-020-01118-0 [doi]
PST - epublish
SO  - Cardiovasc Diabetol. 2020 Sep 30;19(1):160. doi: 10.1186/s12933-020-01118-0.