Time to exacerbation of heart failure is longer in Malaysian population on dipeptidyl peptidase-4 inhibitor

Context: Diabetes mellitus is a recognized risk factor for heart failure. Dipeptidyl peptidase-4 inhibitors (DPP4i) are used in patients with diabetes largely due to its efficacy in glycated hemoglobin (HbA1c) reduction, neutral weight effect, and lower hypoglycemic events. New antidiabetic medications such as the glitazones have been linked with increasing mortality and heart failure exacerbations. The effect of DPP4i in heart failure has not been shown in a heterogenous Asian population. Aims: The aim of this study was to assess incidence of heart failure and cardiovascular (CV) events in patients with diabetes with known coronary artery disease (CAD) treated with DPP4i. Subjects and Methods: This was a single-center, retrospective analysis of patients with diabetes mellitus attending various specialist clinics in Universiti Teknologi MARA treated with available DPP4i agents from January 2013 to July 2015. Medical records were reviewed and data collected for demographic, anthropometric, laboratory, and treatment modalities. Endpoints include changes in body weight, body mass index, lipid, renal profile, and CV events during follow-up. Results: Three hundred and twenty-three patients with diabetes were screened and 307 fulfilled the inclusion criteria. Fifty-four were on linagliptin, 115 were on vildagliptin, and 154 were on saxagliptin. Majority of patients (87.6%) had uncontrolled diabetes at baseline (HbA1c, %) (8.9 ± 2.07). There was a significant reduction in HbA1c from baseline to visit 1 at 3 months (P = 0.000). Similarly, significant improvement in HbA1c seen from baseline to visit 1 (P = 0.000). A higher CV event rate was found between 20 and 30 weeks of therapy with DPP4i. The cumulative survival was 99.5% at 20 weeks and reduced to 98.75% at 30 weeks (P = 0.033). There were seven reported events (0.98%) due to heart failure or acute coronary syndrome. These participants had higher baseline HbA1c and creatinine compared to the overall cohort. Conclusions: Higher CV events were seen in diabetic patients with known CAD treated with DPP4i between 20 and 30 weeks of therapy and occurred earlier in patients with chronic kidney disease. This is later than published data and raises the need to monitor this group of patients for symptoms of heart failure beyond conventional monitoring