1.
Dipeptidyl peptidase-4 inhibitors and risk of heart failure in type 2 diabetes: systematic review and meta-analysis of randomised and observational studies.
Li, L, Li, S, Deng, K, Liu, J, Vandvik, PO, Zhao, P, Zhang, L, Shen, J, Bala, MM, Sohani, ZN, et al
BMJ (Clinical research ed.). 2016;:i610
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Abstract
OBJECTIVES To examine the association between dipeptidyl peptidase-4 (DPP-4) inhibitors and the risk of heart failure or hospital admission for heart failure in patients with type 2 diabetes. DESIGN Systematic review and meta-analysis of randomised and observational studies. DATA SOURCES Medline, Embase, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov searched up to 25 June 2015, and communication with experts. ELIGIBILITY CRITERIA Randomised controlled trials, non-randomised controlled trials, cohort studies, and case-control studies that compared DPP-4 inhibitors against placebo, lifestyle modification, or active antidiabetic drugs in adults with type 2 diabetes, and explicitly reported the outcome of heart failure or hospital admission for heart failure. DATA COLLECTION AND ANALYSIS Teams of paired reviewers independently screened for eligible studies, assessed risk of bias, and extracted data using standardised, pilot tested forms. Data from trials and observational studies were pooled separately; quality of evidence was assessed by the GRADE approach. RESULTS Eligible studies included 43 trials (n=68,775) and 12 observational studies (nine cohort studies, three nested case-control studies; n=1,777,358). Pooling of 38 trials reporting heart failure provided low quality evidence for a possible similar risk of heart failure between DPP-4 inhibitor use versus control (42/15,701 v 33/12,591; odds ratio 0.97 (95% confidence interval 0.61 to 1.56); risk difference 2 fewer (19 fewer to 28 more) events per 1000 patients with type 2 diabetes over five years). The observational studies provided effect estimates generally consistent with trial findings, but with very low quality evidence. Pooling of the five trials reporting admission for heart failure provided moderate quality evidence for an increased risk in patients treated with DPP-4 inhibitors versus control (622/18,554 v 552/18,474; 1.13 (1.00 to 1.26); 8 more (0 more to 16 more)). The pooling of adjusted estimates from observational studies similarly suggested (with very low quality evidence) a possible increased risk of admission for heart failure (adjusted odds ratio 1.41, 95% confidence interval 0.95 to 2.09) in patients treated with DPP-4 inhibitors (exclusively sitagliptin) versus no use. CONCLUSIONS The relative effect of DPP-4 inhibitors on the risk of heart failure in patients with type 2 diabetes is uncertain, given the relatively short follow-up and low quality of evidence. Both randomised controlled trials and observational studies, however, suggest that these drugs may increase the risk of hospital admission for heart failure in those patients with existing cardiovascular diseases or multiple risk factors for vascular diseases, compared with no use.
2.
Shengmai (a traditional Chinese herbal medicine) for heart failure.
Chen, J, Wu, G, Li, S, Yu, T, Xie, Y, Zhou, L, Wang, L
The Cochrane database of systematic reviews. 2007;(4):CD005052
Abstract
BACKGROUND Heart failure is a major public health problem world-wide. Shengmai (a traditional Chinese herbal medicine) has long been used as a complementary treatment for heart failure in China. OBJECTIVES To determine the effect (both benefits and harms) of shengmai plus usual treatment versus usual treatment alone for heart failure. SEARCH STRATEGY We searched the following electronic databases: the Cochrane Central Register of Controlled Trials (CENTRAL) on The Cochrane Library (Issue 2, 2005), MEDLINE (1966 to May 2005), EMBASE (1984 to March 2004), AMED (1985 to July 2005), Chinese BioMedical Literature Database(1978 to April 2004), DARE (Issue 2, 2005) and BIOSIS (1997 to 2004). Seventeen Chinese journals were also handsearched. SELECTION CRITERIA Trials of shengmai plus usual treatment versus usual treatment alone for heart failure were included. Randomized or quasi-randomized controlled trials, regardless of whether they were blinded, were included. DATA COLLECTION AND ANALYSIS Two reviewers selected trials, assessed methodological quality and extracted data independently. Dichotomous and continuous data were calculated as relative risk (RR), and weighted mean differences (WMD), respectively. No heterogeneity was detected between included trials. A fixed-effect model was used to perform meta-analysis. MAIN RESULTS Nineteen trials were included studies. Methodological quality of the included studies was low. Compared to usual treatment alone, shengmai plus usual treatment showed significant improvement in New York Heart Association classification of clinical status (RR 0.32; 95% CI 0.25 to 0.40), mortality (RR 0.25; 95% CI 0.07 to 0.86), and tumour necrosis factor-alpha (WMD -0.52; 95% CI -0.99 to -0.05). Improvements were also seen in hemodynanic tests (one trial, 100 participants). No adverse affects were reported in any of the included trials. AUTHORS' CONCLUSIONS It is possible that shengmai plus usual treatment may be beneficial compared to usual treatment alone for heart failure. However the evidence is weak because of the poor quality of the included trials. Long-term and high quality studies are needed to provide clear evidence for the future use of shengmai.