Metformin use may moderate the effect of DPP-4 inhibitors on cardiovascular outcomes

Williams, J.W., Jr., J.B. Buse, D.A. D'Alessio, M.J. Crowley, A.S. Kosinski
2017
Objective: To explore prevalent metformin use as a potential moderator of the cardiovascular effects of dipeptidyl peptidase 4 inhibitors (DPP-4i). Research Design and Methods: We performed a meta-analysis of the three major cardiovascular outcomes trials examining DPP-4i. We used meta-regression to examine how the cardiovascular effects of DPP-4i differ between prevalent metformin users and baseline nonusers. Results: While prevalent metformin users experienced a trend toward improved
more » ... d improved cardiovascular outcomes with DPP-4i (summary hazard ratio [HR] 0.92 [95% CI 0.84, 1.01]), baseline metformin nonusers showed a trend toward harm(HR 1.10 [95% CI 0.97, 1.26]). The difference in overall DPP-4i effect between metformin user and nonuser subgroups was statistically significant (P = 0.036). Conclusions: Baseline metformin status may have a moderating effect on cardiovascular outcomes with DPP-4i use. This hypothesis-generating analysis suggests there is residual uncertainty as to how DPP-4i affect cardiovascular outcomes, depending on concurrently prescribed medications.
doi:10.17615/bzn1-fb75 fatcat:rgop7p5fkvej3niw3epezbkxf4