Issue 181 Item 5 Acarbose Reduces Cardiovascular Events

First prospective, randomized study to confirm the hypothesis that high postprandial glucose levels contribute to cardiovascular disease.

Treatment of patients with impaired glucose tolerance with acarbose led to a substantial drop in the incidence of cardiovascular events during 3.3 years of follow-up in a controlled study with about 1,400 patients.

Dr. Uwe Zeymer presented the results at the annual congress of the European Society for Cardiology. Acarbose (Precose) delays glucose release from carbohydrates, thereby limiting postprandial spikes in blood glucose levels. The study was sponsored by acarbose maker Bayer.

The report by Dr. Zeymer focused on a secondary end point of the STOP-NIDDM (Study to Prevent Non-Insulin-Dependent Diabetes Mellitus) trial. The study’s primary end point was the reduction of new cases of type 2 diabetes. A prior report from the study showed that a regimen of 100 mg of acarbose t.i.d was associated with a 32% incidence of new-onset diabetes, compared with a 42% incidence in the placebo group, a statistically significant difference (Lancet 359[9323]:2072-77, 2002).

The study enrolled people who had Prediabetes with blood-glucose levels of 140-200 mg/dL 2 hours after an oral glucose challenge. Eligible participants also had fasting levels of blood glucose of 100-140 mg/dL and no recent cardiovascular events.

After 3.3 years of treatment, the 682 evaluable people who received acarbose had 16 cardiovascular events (2.3%), compared with 39 events (5.7%) among the 686 evaluable people treated with placebo, a statistically significant difference, reported Dr. Zeymer of the Ludwigshafen (Germany) Clinic. The results showed that treating 29 people with impaired glucose tolerance with acarbose for 3.3 years would prevent one cardiovascular event.