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Letters Dipeptidyl peptidase-4 inhibitors and risk of heart failure in type 2 diabetes

Pooled patient level data are better suited than study level data to investigate the link between dipeptidyl peptidase-4 inhibitors and the risk of heart failure in type 2 diabetes

BMJ 2016; 353 doi: (Published 24 May 2016) Cite this as: BMJ 2016;353:i2920
  1. Tejas Patel, ORISE fellow1,
  2. Bereket Tesfaldet, ORISE fellow1,
  3. Charu Gandotra, assistant professor and director, nuclear cardiology2
  4. On behalf of the Meta-AnalyTical Interagency Group (MATIG) (Keith Burkhart, MD; Henry Chang, MD; Jue Chen, MS, PhD; Sean Coady, MS; Lawton Cooper, MD; Gyorgy Csako, MD; Michelle Fennessy, RN, PhD; Jerome Fleg, MD; Ahmed Hasan, MD, PhD, FACC; Ruth Kirby, BS, RN; Eileen Navarro Almario, MD, MS, FACP; Frank Pucino, PharmD, MPH; Subha Raman, MD; Yves Rosenberg, MD, MPH; George Sopko, MD; Helena Sviglin, MPH; Robert Wesley, PhD.
  1. 1Food and Drug Administration, 10993 New Hampshire Avenue, Silver Spring, MD 20993, USA
  2. 2Division of Cardiovascular Medicine, Department of Internal Medicine, Howard University Hospital, Washington, DC, USA
  1. tejaskumar.patel{at}

Li and colleagues’ systematic review and meta-analysis included a large number of studies and diverse populations of patients with diabetes.1 However, certain limitations make it difficult to interpret the results. Firstly, durations of exposure and length of follow-up varied between trials, making it difficult to assess the effect of treatment duration on the occurrence of heart failure. Secondly, dipeptidyl peptidase-4 (DPP-4) inhibitors were used both as monotherapy and in combination with other antihyperglycaemic agents, making it difficult to determine a direct causal association between DPP-4 inhibition and heart failure. Thirdly, heart failure events were not always prespecified, well defined, or adjudicated across trials. Finally, study level meta-analyses and systematic reviews lack the ability to identify or …

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