Cardiovascular events associated with second-line anti-diabetes treatments: analysis of real-world Korean data

K. H. Ha, B. Kim, H. Choi, D. J. Kim, H. C. Kim

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Aim: To compare the risks of cardiovascular disease (CVD) and all-cause mortality associated with sulfonylurea (SU), dipeptidyl peptidase-4 inhibitor (DPP4i) and thiazolidinedione (TZD) as add-on medications to metformin (MET) therapy in people with Type 2 diabetes. Methods: We identified 40 263 individuals who used SU (n = 11 582), DPP4i (n = 26 623) or TZD (n = 2058) in addition to MET between January 2013 and June 2015 from the database of the Korean National Health Insurance, the single-payer healthcare system in South Korea. Cox proportional hazard models were used to estimate hazard ratios for major CVD event (coronary artery disease, heart failure, stroke or transient ischaemic attack) development and all-cause mortality by second-line anti-diabetes medication type. Age, sex, duration of MET monotherapy, calendar year and comorbid conditions were adjusted as potential confounders. Results: The observed numbers of CVD events (total observed person-time) were 485 (18 778 person-years) for MET + SU, 744 (40 374 person-years) for MET + DPP4i and 60 (3014 person-years) for MET + TZD users. Compared with MET + SU users, the fully adjusted hazard ratios for CVD events were 0.79 [95% confidence interval (CI): 0.71–0.89] for MET + DPP4i users and 0.85 (95% CI: 0.65–1.11) for MET + TZD users. The corresponding hazard ratios for all-cause mortality were 0.84 (95% CI: 0.66–1.07) for MET + DPP4i users and 0.67 (95% CI: 0.35–1.28) for MET + TZD users. Conclusion: Analysis of Korea National Health Insurance database showed that MET + DPP4i treatment for diabetes had a lower CVD risk than MET + SU treatment.

Original languageEnglish
Pages (from-to)1235-1243
Number of pages9
JournalDiabetic Medicine
Volume34
Issue number9
DOIs
Publication statusPublished - 2017 Sep

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Metformin
Dipeptidyl-Peptidase IV Inhibitors
Cardiovascular Diseases
Confidence Intervals
National Health Programs
Single-Payer System
Mortality
Databases
Republic of Korea
Transient Ischemic Attack
Korea
Proportional Hazards Models
Type 2 Diabetes Mellitus
Coronary Artery Disease
Heart Failure
Stroke

All Science Journal Classification (ASJC) codes

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Endocrinology

Cite this

@article{4d10daeec56d4022800066b361e098f3,
title = "Cardiovascular events associated with second-line anti-diabetes treatments: analysis of real-world Korean data",
abstract = "Aim: To compare the risks of cardiovascular disease (CVD) and all-cause mortality associated with sulfonylurea (SU), dipeptidyl peptidase-4 inhibitor (DPP4i) and thiazolidinedione (TZD) as add-on medications to metformin (MET) therapy in people with Type 2 diabetes. Methods: We identified 40 263 individuals who used SU (n = 11 582), DPP4i (n = 26 623) or TZD (n = 2058) in addition to MET between January 2013 and June 2015 from the database of the Korean National Health Insurance, the single-payer healthcare system in South Korea. Cox proportional hazard models were used to estimate hazard ratios for major CVD event (coronary artery disease, heart failure, stroke or transient ischaemic attack) development and all-cause mortality by second-line anti-diabetes medication type. Age, sex, duration of MET monotherapy, calendar year and comorbid conditions were adjusted as potential confounders. Results: The observed numbers of CVD events (total observed person-time) were 485 (18 778 person-years) for MET + SU, 744 (40 374 person-years) for MET + DPP4i and 60 (3014 person-years) for MET + TZD users. Compared with MET + SU users, the fully adjusted hazard ratios for CVD events were 0.79 [95{\%} confidence interval (CI): 0.71–0.89] for MET + DPP4i users and 0.85 (95{\%} CI: 0.65–1.11) for MET + TZD users. The corresponding hazard ratios for all-cause mortality were 0.84 (95{\%} CI: 0.66–1.07) for MET + DPP4i users and 0.67 (95{\%} CI: 0.35–1.28) for MET + TZD users. Conclusion: Analysis of Korea National Health Insurance database showed that MET + DPP4i treatment for diabetes had a lower CVD risk than MET + SU treatment.",
author = "Ha, {K. H.} and B. Kim and H. Choi and Kim, {D. J.} and Kim, {H. C.}",
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Cardiovascular events associated with second-line anti-diabetes treatments : analysis of real-world Korean data. / Ha, K. H.; Kim, B.; Choi, H.; Kim, D. J.; Kim, H. C.

In: Diabetic Medicine, Vol. 34, No. 9, 09.2017, p. 1235-1243.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Cardiovascular events associated with second-line anti-diabetes treatments

T2 - analysis of real-world Korean data

AU - Ha, K. H.

AU - Kim, B.

AU - Choi, H.

AU - Kim, D. J.

AU - Kim, H. C.

PY - 2017/9

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N2 - Aim: To compare the risks of cardiovascular disease (CVD) and all-cause mortality associated with sulfonylurea (SU), dipeptidyl peptidase-4 inhibitor (DPP4i) and thiazolidinedione (TZD) as add-on medications to metformin (MET) therapy in people with Type 2 diabetes. Methods: We identified 40 263 individuals who used SU (n = 11 582), DPP4i (n = 26 623) or TZD (n = 2058) in addition to MET between January 2013 and June 2015 from the database of the Korean National Health Insurance, the single-payer healthcare system in South Korea. Cox proportional hazard models were used to estimate hazard ratios for major CVD event (coronary artery disease, heart failure, stroke or transient ischaemic attack) development and all-cause mortality by second-line anti-diabetes medication type. Age, sex, duration of MET monotherapy, calendar year and comorbid conditions were adjusted as potential confounders. Results: The observed numbers of CVD events (total observed person-time) were 485 (18 778 person-years) for MET + SU, 744 (40 374 person-years) for MET + DPP4i and 60 (3014 person-years) for MET + TZD users. Compared with MET + SU users, the fully adjusted hazard ratios for CVD events were 0.79 [95% confidence interval (CI): 0.71–0.89] for MET + DPP4i users and 0.85 (95% CI: 0.65–1.11) for MET + TZD users. The corresponding hazard ratios for all-cause mortality were 0.84 (95% CI: 0.66–1.07) for MET + DPP4i users and 0.67 (95% CI: 0.35–1.28) for MET + TZD users. Conclusion: Analysis of Korea National Health Insurance database showed that MET + DPP4i treatment for diabetes had a lower CVD risk than MET + SU treatment.

AB - Aim: To compare the risks of cardiovascular disease (CVD) and all-cause mortality associated with sulfonylurea (SU), dipeptidyl peptidase-4 inhibitor (DPP4i) and thiazolidinedione (TZD) as add-on medications to metformin (MET) therapy in people with Type 2 diabetes. Methods: We identified 40 263 individuals who used SU (n = 11 582), DPP4i (n = 26 623) or TZD (n = 2058) in addition to MET between January 2013 and June 2015 from the database of the Korean National Health Insurance, the single-payer healthcare system in South Korea. Cox proportional hazard models were used to estimate hazard ratios for major CVD event (coronary artery disease, heart failure, stroke or transient ischaemic attack) development and all-cause mortality by second-line anti-diabetes medication type. Age, sex, duration of MET monotherapy, calendar year and comorbid conditions were adjusted as potential confounders. Results: The observed numbers of CVD events (total observed person-time) were 485 (18 778 person-years) for MET + SU, 744 (40 374 person-years) for MET + DPP4i and 60 (3014 person-years) for MET + TZD users. Compared with MET + SU users, the fully adjusted hazard ratios for CVD events were 0.79 [95% confidence interval (CI): 0.71–0.89] for MET + DPP4i users and 0.85 (95% CI: 0.65–1.11) for MET + TZD users. The corresponding hazard ratios for all-cause mortality were 0.84 (95% CI: 0.66–1.07) for MET + DPP4i users and 0.67 (95% CI: 0.35–1.28) for MET + TZD users. Conclusion: Analysis of Korea National Health Insurance database showed that MET + DPP4i treatment for diabetes had a lower CVD risk than MET + SU treatment.

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