Which diabetic medications are least likely to cause heart disease?

This study examined the risk of major heart complications in patients taking a type of diabetic medication called DPP4-inhibitors. They found that patients taking DPP4-inhibitors were less likely to develop major heart disease than patients taking sulfonylureas. 

Patients with type 2 diabetes (T2D) are at risk of developing complications such as heart attack and stroke. These complications are also known as major adverse cardiac events (MACE). MACE is an umbrella term for heart attack, heart surgery, heart failure and stroke.

Some of the medications used to treat diabetes can increase the risk of developing MACE. Sulfonylureas such as glimepiride (Amaryl) are known to increase the risk of heart disease. Metformin (Glucophage) has been shown to be safe in this way. 

DPP4-inhibitors are a type of medication used to treat diabetes. DPP4-inhibitors are a type of medication that help the body to produce its own insulin. Examples of DPP-4 inhibitors include sitagliptin (Januvia) and linagliptin (Trajenta). There is some uncertainty about whether DPP4-inhibitors increase the risk of MACE in patients with diabetes.

This study involved 445,701 patients aged 35-65 with T2D and no known heart problems. These patients were all started on either DPP4-inhibitors, sulfonylureas or metformin. Patients were followed to see if they developed MACEs.

Patients taking DPP4-inhibitors were 13% less likely to develop MACE than patients taking sulfonylureas. Patients taking DPP4-inhibitors had a similar risk of developing MACEs compared to those taking metformin. Compared to patients taking sulfonylureas, those taking DPP4-inhibitors had a 30% lower risk for heart attacks and a 43% lower risk for stroke and heart failure.

This study showed that patients taking DPP4-inhibitors were less likely to have major heart complications than patients taking sulfonylureas and similar risks to those taking metformin . 

This study only included patients who were at low risk of developing MACE. Further studies are needed to ensure that DPP4-i are also safe for patients at high risk of heart complications.