First prospective intervention study testing the postprandial hyperglycemia hypotheses as a risk factor for cardiovascular disease. “Acarbose treatment was associated with a relative risk reduction of 49% for cardiovascular events.
Treatment with acarbose, an alpha-glucosidase inhibitor, resulted in a significant reduction in the risk of developing hypertension and cardiovascular disease in patients with impaired glucose tolerance, according to findings from the STOP-Noninsulin-Dependent Diabetes Mellitus (NIDDM) trial.
"This is the first prospective intervention study testing the postprandial hyperglycemia hypotheses as a risk factor for cardiovascular disease," write Jean-Louis Chiasson, MD, of the University of Montreal, Quebec, Canada and colleagues.
They analyzed the effect of three times a day of 100 mg acarbose or placebo in a cohort of patients with impaired glucose tolerance and a fasting glucose concentration between 100 and 140 mg/dL. The patients were a mean age of 54.5 years, had a mean body mass index (BMI) of 30.9, and had no cardiovascular events within 6 months prior to enrollment. Mean blood pressure was 131.1 mm Hg systolic and 82.4 mm Hg diastolic.
The 1,368 patients were followed for a mean of 3.3 years. Twenty-four percent (211 taking acarbose and 130 taking placebo) discontinued participation, mostly during the first year, commonly due to adverse gastrointestinal effects.
Among the 682 patients taking acarbose, 11% of patients developed hypertension, defined as a mean of at least 140/90 mm Hg from 3 measurements. Among the 686 placebo patients 17% developed hypertension. Thus, the researchers report that acarbose therapy was associated with a 34% relative risk reduction in the incidence of new hypertension cases.
Of the patients taking acarbose, 15 had at least one cardiovascular event compared with 32 cardiovascular events in the placebo group. "Acarbose treatment was therefore associated with a relative risk reduction of 49% for cardiovascular events," the researchers write. The major reduction was in the risk of myocardial infarction (MI). The researchers report that two patients taking acarbose experienced MI (one clinical and one silent) compared with 19 MIs (12 clinical and seven silent) in those taking placebo.
Dr. Chiasson and colleagues conclude, "these observations are compatible with the hypothesis that postprandial hyperglycemia is a risk factor for cardiovascular disease." They add that these findings, "provide further arguments for screening and treating patients with impaired glucose tolerance."