Association between use of oral-antidiabetic drugs and the risk of aortic aneurysm: A nested case-control analysis

Chien Yi Hsu, Yu Wen Su, Yung Tai Chen, Shih Hung Tsai, Chun Chin Chang, Szu Yuan Li, Po Hsun Huang, Jaw Wen Chen, Shing Jong Lin

Research output: Contribution to journalArticle

22 Citations (Scopus)

Abstract

Background: Pleiotropic effects on cardiovascular protection have been suggested in several oral antidiabetic drugs (OAD). The impacts of OADs on aortic aneurysm (AA) growth have been found in animal studies, but the evidence of their beneficial effects for AA protection in human are lacking. We investigated the relationship between OAD therapy and the risk of developing AA. Methods: We conducted a nested case-control analysis using the database extracted from Taiwan's National Health Insurance Research Database. The database consists of 1.2 million diabetic patients representing the majority of the type 2 diabetes population in Taiwan from 2000 to 2013. Cases were identified as those with either inpatient or outpatient diagnosis code of AA. One control was selected for each case matching on duration of follow-up, age, sex, urbanization, monthly income, severity of diabetes, and risk factor for AA. We identified variable classes of OADs, including metformin, sulfonylureas, thiazolidinedione (TZD), alpha-glucosidase inhibitors, meglitinide, dipeptidyl peptidase-4 (DPP-4) inhibitors prior to the development of AA. Results: A total of 4468 cases diagnosed with AA and 4468 matched controls were identified. Metformin use, sulfonylurea use, and TZD were associated with lower risk of developing AA, odds ratio [OR] 0.72 (95 % confidence interval [CI] 0.64-0.80), 0.82 (95 % CI 0.74-0.92), and 0.82 (95 % CI 0.69-0.98), respectively. The effects of metformin and sulfonylurea on AA were dose responsive. Neither alpha-glucosidase inhibitors (OR 0.95; 95 % CI 0.81-1.11) nor DPP-4 inhibitors (OR 0.85; 95 % CI 0.68-1.07) was significantly associated with AA events. Conclusions: Metformin, sulfonylurea, and TZD treated patients were associated with lower risks of AA development, but not DPP-4 inhibitors or alpha-glucosidase inhibitor. The protective effects of hypoglycemic agents are further confirmed by the dose responsive relations in metformin and sulfonylurea groups.

Original languageEnglish
Article number125
JournalCardiovascular Diabetology
Volume15
Issue number1
DOIs
Publication statusPublished - Sep 1 2016

Fingerprint

Aortic Aneurysm
Hypoglycemic Agents
Metformin
Dipeptidyl-Peptidase IV Inhibitors
Confidence Intervals
Odds Ratio
Databases
Taiwan
Urbanization
National Health Programs
Type 2 Diabetes Mellitus
Inpatients
Outpatients
Drug Therapy

Keywords

  • Aortic aneurysm
  • Diabetes mellitus
  • Oral antidiabetic drugs

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Cardiology and Cardiovascular Medicine

Cite this

Association between use of oral-antidiabetic drugs and the risk of aortic aneurysm : A nested case-control analysis. / Hsu, Chien Yi; Su, Yu Wen; Chen, Yung Tai; Tsai, Shih Hung; Chang, Chun Chin; Li, Szu Yuan; Huang, Po Hsun; Chen, Jaw Wen; Lin, Shing Jong.

In: Cardiovascular Diabetology, Vol. 15, No. 1, 125, 01.09.2016.

Research output: Contribution to journalArticle

Hsu, Chien Yi ; Su, Yu Wen ; Chen, Yung Tai ; Tsai, Shih Hung ; Chang, Chun Chin ; Li, Szu Yuan ; Huang, Po Hsun ; Chen, Jaw Wen ; Lin, Shing Jong. / Association between use of oral-antidiabetic drugs and the risk of aortic aneurysm : A nested case-control analysis. In: Cardiovascular Diabetology. 2016 ; Vol. 15, No. 1.
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AU - Chen, Yung Tai

AU - Tsai, Shih Hung

AU - Chang, Chun Chin

AU - Li, Szu Yuan

AU - Huang, Po Hsun

AU - Chen, Jaw Wen

AU - Lin, Shing Jong

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N2 - Background: Pleiotropic effects on cardiovascular protection have been suggested in several oral antidiabetic drugs (OAD). The impacts of OADs on aortic aneurysm (AA) growth have been found in animal studies, but the evidence of their beneficial effects for AA protection in human are lacking. We investigated the relationship between OAD therapy and the risk of developing AA. Methods: We conducted a nested case-control analysis using the database extracted from Taiwan's National Health Insurance Research Database. The database consists of 1.2 million diabetic patients representing the majority of the type 2 diabetes population in Taiwan from 2000 to 2013. Cases were identified as those with either inpatient or outpatient diagnosis code of AA. One control was selected for each case matching on duration of follow-up, age, sex, urbanization, monthly income, severity of diabetes, and risk factor for AA. We identified variable classes of OADs, including metformin, sulfonylureas, thiazolidinedione (TZD), alpha-glucosidase inhibitors, meglitinide, dipeptidyl peptidase-4 (DPP-4) inhibitors prior to the development of AA. Results: A total of 4468 cases diagnosed with AA and 4468 matched controls were identified. Metformin use, sulfonylurea use, and TZD were associated with lower risk of developing AA, odds ratio [OR] 0.72 (95 % confidence interval [CI] 0.64-0.80), 0.82 (95 % CI 0.74-0.92), and 0.82 (95 % CI 0.69-0.98), respectively. The effects of metformin and sulfonylurea on AA were dose responsive. Neither alpha-glucosidase inhibitors (OR 0.95; 95 % CI 0.81-1.11) nor DPP-4 inhibitors (OR 0.85; 95 % CI 0.68-1.07) was significantly associated with AA events. Conclusions: Metformin, sulfonylurea, and TZD treated patients were associated with lower risks of AA development, but not DPP-4 inhibitors or alpha-glucosidase inhibitor. The protective effects of hypoglycemic agents are further confirmed by the dose responsive relations in metformin and sulfonylurea groups.

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