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Acarbose Treatment and the Reduction of CVD Risk in Type 2 Diabetes Patients

Aug 8, 2014
 

Previous studies have shown that decreasing postprandial hyperglycemia with acarbose could reduce the risk of CV events but a new study shows that risk may increase for the first 12 months of exposure…. 

Several observational studies and randomized controlled studies, including the STOP-NIDDM study, have shown that decreasing postprandial hyperglycemia with acarbose could reduce the risk of cardiovascular events. However, most of these studies are limited by their small sample size and short duration of follow up.

Based on data extracted from Taiwan’s National Health Insurance Research Database (NHIRD), Chen and colleagues identified diabetic patients using the ICD-9-CM code with at least 3 outpatient visits or hospitalization treatments. Inclusion criteria for the study included: diagnosed with diabetes between 2003 and 2008; age older than 30 years and less than 100 years as of Jan. 1, 2003; no diagnosis of cardiovascular disease before year 2003 or 1 year prior to the diagnosis of diabetes. Patients with type 1 diabetes and with unknown sex were excluded from the study. The follow-up period began from Jan. 1, 2003 and ended in Dec. 31, 2010. The primary endpoint was cardiovascular diseases that identified using ICD-9 codes.

A total of 644,792 newly diagnosed type 2 diabetic patients without preexisting CVD were enrolled. Among these patients,109,139 had received acarbose treatment and were analyzed for CVD risk.

The results showed that during 7 years of follow up, 5,081 patients (4.7%) who received acarbose treatment developed CVD compared to 33,203 patients (6.2%) who did not receive acarbose therapy. In addition, 2,619 patients who received acarbose treatment developed stroke compared to 18,212 patient who never received acarbose therapy. The crude hazard ratio (HR) of acarbose users who developed CVD was 0.66 (95% CI 0.641-0.680, P<0.001), and the adjusted HR of CVD was 1.19, 0.70, and 0.38 when the duration of acarbose use was <12 months, 12–24 months, and >24 month. For patients who had a first event of CVD, continuous use of acarbose for <12 months resulted in an adjusted HR of 1 (95% CI 0.891-1.132, P = 0.947).

Acarbose, either used as a monotherapy or in combination, had a unique impact on the subsequent development of CVD in type 2 diabetes patients. Acarbose was shown to increase the risk of CVD in the first 12 months of exposure. However, after the initial 12 month period, acarbose treatment resulted in significant reductions of CVD risk. After the first CVD events, continuous use of acarbose had a neutral effect within the first 12 months.

Practice Pearls:

  • Acarbose, either used as a monotherapy or in combination, had a unique impact on the subsequent development of CVD in type 2 diabetes patients.
  • Acarbose increased the risk of CVD in the first 12 months of exposure.
  • Acarbose decreased the risk of CVD significantly in prolonged user (more than 12 months of exposure.)

Chen J, Chang C, Lin Y. Acarbose Treatment and the Risk of Cardiovascular Disease in Type 2 Diabetic Patients: A Nationwide Seven-Year Follow-Up Study. Journal of Diabetes Research. 2014: n. pag. Web. 3 Aug 2014.