Cardiovascular disease (CVD) accounts for almost 80% of deaths in type 2 diabetes patients. According to a recent study (Nichols, etc al., Diab Care, 2002) the prevalence of acute myocardial infarction and congestive heart failure is particularly high in patients with diabetes.

It is now known that the risk of CVD increases at levels of glycaemia far below clinically used to diagnose diabetes. Epidemiological studies also show that the risk of cardiovascular mortality is higher in people with impaired glucose intolerance (IGT), a state of prediabetes, and that impaired glucose intolerance is common in those who have suffered an acute myocardial infarction.

Glucobay reduces the risk of cardiovascular disease

The multicentre Study to Prevent Non-insulin Dependent Diabetes Mellitus (STOP-NIDDM) randomized 1,429 individuals with IGT (2hPG level 7.8 - 11.0 mmol/L and FPG 5.6 - 7.7 mmol/L) to receive acarbose or placebo for 3 years.

Compared with placebo, acarbose was shown to significantly reduce the development of established diabetes by 36% based on the stricter criterion of two OGTTs. A number of secondary endpoints concerning the development of CVD were also analyzed. Acarbose reduced the risk of any cardiovascular event by 49% (p=0.03), and in particular, decreased the risk of myocardial infarction (MI) by an impressive 91% (p=0.02).

Glucobay is effective in pre- and established diabetes

The STOP-NIDDM results prompted questions about the ability of acarbose to reduce cardiovascular risk in patients with established type 2 diabetes, and a meta-analysis of seven randomized, placebo-controlled, long-term trials, involving 2,180 diabetic patients, was carried out.

Acarbose therapy was shown to reduce the risk of all the cardiovascular event categories measured. The risk of any cardiovascular event was reduced by 35% (p=0.0061), with the risk of MI decreasing by 64% (p=0.012), compared with placebo.

Results from the STOP-NIDDM and acarbose meta-analysis showed, for the first time, that pharmacological intervention with acarbose to reduce postprandial hyperglycaemia can significantly reduce the risk of cardiovascular events in individuals with impaired glucose tolerance and established type 2 diabetes.

The effect of Acarbose was evident despite a large number of participants reveiving 'state-of-the-art' concomitant cardiovascular medication. These results were supported by a further substudy of the STOP-NIDDM trial on the effect of acarbose on the progression of intima-media-thickness (IMT). In conclusion, acarbose treatment delays progression of IMT in subjects with IGT, a state of high risk for diabetes and atherosclerosis. This is the first placebo-controlled intervention subgroup analysis demonstrating that counterbalancing of postprandial hyperglycemia may be vasoprotective.

As acarbose is proven to maintain blood glucose control in the long term, the added ability to significantly reduce cardiovascular risk in type 2 diabetes patients highlights this agent as the optimal first-line therapy for these individuals.

Chiasson et al., JAMA 290: 486-494 (2003)
Hanefeld et al., Stroke 35: 1073-1078 (2004)
Hanefeld et al., Eur Heart J 25: 10-16 (2004)
Delorme et al., Curr Opin Pharmacol 5: 184-189 (2005)

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