Previous real-world database studies have concluded that SGLT2 inhibitors are superior to DPP-4 inhibitors in reducing the risk of major adverse cardiac or cerebrovascular events, especially heart failure events (Ng et al., 2025; Kim et al., 2024; D'Andrea et al., 2023; Xie et al., 2023; Rhee et al., 2022; Han et al., 2021; Persson et al., 2018; Filion et al., 2020). Here, DPP4 is linked to heart failure.