Metformin Use May Moderate the Effect of DPP-4 Inhibitors on Cardiovascular Outcomes.


Journal Article

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 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.

Full Text

Duke Authors

Cited Authors

  • Crowley, MJ; Williams, JW; Kosinski, AS; D'Alessio, DA; Buse, JB

Published Date

  • December 2017

Published In

Volume / Issue

  • 40 / 12

Start / End Page

  • 1787 - 1789

PubMed ID

  • 29051159

Pubmed Central ID

  • 29051159

Electronic International Standard Serial Number (EISSN)

  • 1935-5548

Digital Object Identifier (DOI)

  • 10.2337/dc17-1528


  • eng

Conference Location

  • United States