Finally, our study is based on the assumption that patients are completely compliant with physicians orders. Conclusion In conclusion, this nationwide, population-based cohort study demonstrated that in type 2 diabetes patients with recent myocardial infarction, the use of sitagliptin is not associated with increased risk of composite adverse cardiovascular outcomes, including myocardial infarction, ischemic stroke, and cardiovascular death. was 9.50 per 100 person-years in the sitagliptin group and was 9.70 per 100 person-years in the comparison group (hazard ratio (HR), 0.97; 95% CI, 0.73C1.29, P=0.849). Compared to the non-sitagliptin group, the sitagliptin group had similar risks of all-cause mortality, hospitalization for heart failure (HF) or percutaneous coronary intervention (PCI) with a HR of 0.82 (95% CI, 0.61C1.11, P=0.195), 0.93 (95% CI, 0.67C1.29, P=0.660), and 0.93 (95% CI, 0.75C1.14, P=0.473), respectively. Conclusion The use of sitagliptin in type 2 diabetic patients with recent AMI was not associated with increased risk of adverse cardiovascular events. Introduction Type 2 diabetes mellitus (T2DM) is usually associated with elevated risk of cardiovascular disease; more than half of patients with diabetes die of Naxagolide cardiovascular complications [1,2]. Diabetic patients who have yet to develop myocardial infarction have comparable cardiovascular risk to that of nondiabetic patients with a prior myocardial infarction. Diabetic patients who have a history of myocardial infarction are at an even higher risk, with a seven-year AMI incidence of 45% [3]. Improved glycemic control has been shown to reduce the risk of microvascular complications of T2DM, but studies have failed to demonstrate that glycemic control reduces the risk of macrovascular events [4C6]. Concerns about adverse cardiovascular events with antidiabetic brokers indicate a clinical need to identify the cardiovascular safety and benefit of antihyperglycemic brokers [7,8]. Sitagliptin is an orally administered dipeptidyl Naxagolide peptidase-4 (DPP-4) inhibitor that exerts antihyperglycemic effects by increasing the availability of incretin hormones, which in turn modulates pancreatic islet hormone secretion [9,10]. Some studies have revealed a decreased risk of adverse cardiovascular events in DPP-4-treated subjects [11] whereas others suggest a neutral effect on MIF cardiovascular events [12C14]. Moreover, results from observational studies have shown that sitagliptin may increase cardiovascular risk [15], especially in patients with chronic kidney disease [16]. As a result, there remains much speculation about the cardiovascular benefit and potential risks of this medication. This nationwide, prospective cohort study aimed to examine sitagliptin use and cardiovascular outcomes in patients with T2DM after AMI. Secondary safety outcomes were also considered. Methods Data Source We conducted this nationwide population-based cohort study using Taiwans National Health Insurance Research Database (NHIRD), a government-operated, population-based database derived from the claims data of Taiwans National Health Insurance program, covering 99.19% of the population [17]. The NHIRD database provides comprehensive and accurate records of beneficiaries, including ambulatory visits, inpatient care, disease diagnosis codes, and medication prescriptions. The accuracy and validity of NHIRD data has been previously confirmed [18C20]. Naxagolide The Ethics Institutional Review Board of Chang Gung Memorial Hospital approved the study. Study Population Patients with a diagnosis of type 2 diabetes ([ICD-9-CM] code 250.xx) were included in this study. We identified patients who were hospitalized for AMI (ICD-9-CM code 410.xx) between March 1st, 2009 and December 31st, 2011. The index hospitalization was defined as the date on which patient was admitted for AMI. Patients baseline characteristics, such as gender and age, were considered. We also identified baseline comorbidities, medication prescription, and previous medical procedures, such as percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG). Patients were excluded if they met any of the following criteria. (Fig 1): (1) age 40 years; (2) expired during index hospitalization for AMI; (3) received sitagliptin treatment before index hospitalization; (4) use of thiazolidinediones or other DPP-4 inhibitors; (5) received renal replacement therapies; (6) developed a composite primary cardiovascular endpoint (defined as death, Naxagolide AMI or ischemic stroke) within 30 days of discharge; (7) were followed for less than 30 days after the index hospitalization; and (8) was diagnosed with T2DM Naxagolide during index hospitalization (defined as patient.