DPP-4i use was associated with a lower risk of MACE among patients with COPD and comorbid DM, suggesting that DPP-4i may provide cardiovascular benefits beyond glycemic control in this high-risk population.
DPP-4i users with COPD and comorbid diabetes had a significantly lower incidence of MACE compared with non-users.
Non-DPP-4i use was associated with a significantly higher adjusted risk of MACE compared with DPP-4i use.
The cardiovascular protective association of DPP-4i use was consistent across multiple patient subgroups.
The study used a nationwide retrospective cohort design drawing from Taiwan's National Health Insurance Research Database over a five-year period.
The authors acknowledged that causal relationships cannot be established due to the observational study design and potential for residual confounding and selection bias.
This research suggests that among people who have both chronic obstructive pulmonary disease (COPD) and diabetes, those who took a class of diabetes medications called DPP-4 inhibitors (such as sitagliptin or saxagliptin) had notably lower rates of serious heart events—including heart attack, stroke, and cardiovascular death—compared to those taking other diabetes medications. Specifically, about 18% of DPP-4 inhibitor users experienced one of these major cardiovascular events during the study period, compared to about 26% of those on other diabetes drugs. After accounting for differences in patient characteristics and health conditions, people not taking DPP-4 inhibitors were 56% more likely to experience a major cardiovascular event. The study analyzed data from over 24,000 patients in Taiwan's national health insurance database between 2016 and 2021, making it one of the larger real-world analyses of this question. The protective association held up across different age groups, sexes, and even among patients who had previously had a heart attack, stroke, or high blood pressure, suggesting the potential benefit is broad. Researchers believe DPP-4 inhibitors may offer heart-protective effects beyond simply controlling blood sugar, possibly through anti-inflammatory actions that could be particularly relevant in COPD, which is itself an inflammatory condition. However, this research suggests an association, not a proven cause-and-effect relationship. Because it is an observational study—meaning researchers looked at real-world prescribing patterns rather than randomly assigning patients to treatments—there may be unmeasured factors that explain the difference in outcomes. The authors themselves emphasize caution in interpreting these results and call for randomized controlled trials to definitively determine whether DPP-4 inhibitors directly protect the heart in people with both COPD and diabetes.
Ho C, Shao Y, Wu Y, Liao K. (2026). Dipeptidyl Peptidase-4 Inhibitor Use and Risk of Major Adverse Cardiovascular Events in Patients with COPD and Diabetes: A Nationwide Retrospective Cohort Study.. International journal of chronic obstructive pulmonary disease. https://doi.org/10.2147/COPD.S608033