Association of antidiabetic medications targeting the glucagon-like peptide 1 pathway and heart failure events in patients with diabetes.
BACKGROUND
Glucagon-like peptide-1 (GLP-1) agonists and dipeptidyl peptidase 4 (DPP-4) inhibitors (GLP-1 agents) may be protective in heart failure (HF). We set out to determine whether GLP-1 agent use is associated with HF risk in diabetics.


METHODS AND RESULTS
In this retrospective cohort study of members of a large health system, we identified >19,000 adult diabetics from January 1, 2000, to July 1, 2012. GLP-1 agent users were matched 1:2 to control subjects with the use of propensity matching based on age, race, sex, coronary disease, HF, diabetes duration, and number of antidiabetic medications. The association of GLP-1 agents with time to HF hospitalization was tested with multivariable Cox regression. All-cause hospitalization and mortality were secondary end points. We identified 1,426 users of GLP-1 agents and 2,798 control subjects. Both were similar except for angiotensin-converting enzyme inhibitors/angiotensin receptor blocker use, number of antidiabetic medications, and age. There were 199 hospitalizations, of which 128 were for HF, and 114 deaths. GLP-1 agents were associated with reduced risk of HF hospitalization (adjusted hazard ratio [aHR] 0.51, 95% confidence interval [CI] 0.34-0.77; P = .002), all-cause hospitalization (aHR 0.54, 95% CI 0.38-0.74; P = .001), and death (aHR 0.31, 95% CI 0.18-0.53; P = .001).


CONCLUSIONS
GLP-1 agents may reduce the risk of HF events in diabetics.
['Velez|Mauricio|M|', 'Peterson|Edward L|EL|', 'Wells|Karen|K|', 'Swadia|Tanmay|T|', 'Sabbah|Hani N|HN|', 'Williams|L Keoki|LK|', 'Lanfear|David E|DE|']
D000368:Aged D015331:Cohort Studies D003924:Diabetes Mellitus, Type 2 D054873:Dipeptidyl-Peptidase IV Inhibitors D016503:Drug Delivery Systems D005260:Female D052216:Glucagon-Like Peptide 1 D006333:Heart Failure D006760:Hospitalization D006801:Humans D007004:Hypoglycemic Agents D008297:Male D008875:Middle Aged D012189:Retrospective Studies
heart failure DPP-4 inhibitor GLP-1 agonist outcomes