Dipeptidyl peptidase-4 inhibitors and the risk of heart failure: a systematic review and meta-analysis
Why this work is in the frame
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Bibliographic record
Abstract
ipeptidyl peptidase-4 (DPP-4) inhibitors are integral in the management of diabetes because of their effective glucose lowering with low risk for hypoglycemia or weight gain. 1 Because heart failure remains a common complication of diabetes and is associated with poor longterm prognosis, 2,3 understanding the potential effects of antihyperglycemic agents on risk for heart failure is of critical and immediate importance. The first large DPP-4 inhibitor versus placebo randomized controlled trial (RCT) Saxagliptin Assessment of Vascular Outcomes Recorded in Patients with Diabetes Mellitus -Thrombolysis in Myocardial Infarction 53 (SAVOR-TIMI 53) (n = 16 492 patients with a history of, or at risk for, cardiovascular events) unexpectedly found a significantly higher rate of heart failure requiring admission to hospital. The second was the Examination of Cardiovascular Outcomes with Alogliptin versus Standard of Care (EXAM-INE) (n = 5380 patients post-acute coronary syndrome), which found a numerical but nonsignificantly higher rate of heart failure requiring hospital admission. In contrast, Trial to Evaluate Cardiovascular Outcomes after Treatment with Sitagliptin (TECOS) (n = 14 735 patients with cardiovascular disease and longer follow-up [median 3.0 yr v. 1.5 and 2.1 yr for EXAMINE and SAVOR-TIMI 53]) found almost identical rates of hospital admission for heart failure in the sitagliptin and placebo groups. he potential safety issue that arose from SAVOR-TIMI 53 and EXAMINE led to the Food and Drug Administration's (FDA) recommendation 9 to consider discontinuing saxagliptin and alogliptin for patients if heart failure develops. Given the apparent discrepant results from TECOS,
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Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.013 | 0.002 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from it