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Acarbose Higher Cardiovascular Risk Than Metformin

According to a new retrospective study acarbose may not have a cardioprotective effect as good as metformin when used as first-line therapy…

This study analyzed 17,366 patients who initiated acarbose therapy and 230,023 who initiated metformin therapy. Both nephropathy and diabetes complication severity index were strongly associated with the patients who initiated acarbose.

The study stated that the “acarbose initiators were older, and had a higher proportion of ischemic heart disease, cerebrovascular disease, hypertension, and dyslipidemia, and a higher diabetes complication severity index.”

Hospitalization for any cardiovascular (CV) event, such as myocardial infarction (MI), congestive heart failure or ischemic stroke, served as the primary outcome.

During an average follow-up period of 1.15 years, 3,672 cases in the acarbose group and 34,717 cases in the metformin group had an outcome occurrence, according to the data.

Intent-to-treat analyses showed that acarbose was associated with a higher risk for any CV event (adjusted HR=1.05; 95% CI, 1.01-1.09), heart failure (HR=1.08; 95% CI, 1.00-1.16) and ischemic stroke (HR=1.05; 95% CI, 1.00-1.10). Subgroup analyses did not find significant differences in subgroups stratified by sex, age, and underlying diseases.

The study authors explained that the study’s huge sample size, which included almost all newly-diagnosed type 2 diabetes patients, and its sufficient number of CV events allowed incidences to be precisely estimated.

The study authors also stated, however, that their study was limited because it was an observational cohort study and not a randomized controlled trial. Further, its follow-up period was very short.

It is important to note that the patients who received acarbose were more likely to have renal dysfunction than those who initiated metformin. The study may have inadvertently enriched for cardiovascular disease in the acarbose group.

Practice Pearls:

  • Acarbose initiators were older, and had a higher proportion of ischemic heart disease, cerebrovascular disease, hypertension, and dyslipidemia, and a higher diabetes complication severity index.
  • Acarbose was associated with a higher risk for any CV event heart failure, and ischemic stroke.
  • Acarbose doesn’t come out as better than metformin.

Chang CH et al. J Clin Endocrinol Metab. 2015;doi:10.1210/jc.2014-2443.