Acarbose Cuts Risk of Hypertension
and CVD For Patients with Impaired Glucose Tolerance
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."
JAMA 2003;290:4:486-494
