Acarbose reduces the risk for diabetes — but not for major adverse cardiovascular events (MACE) — in patients with coronary heart disease (CHD) and concomitant glucose intolerance, according to a randomized, double-blind, phase 4 trial published in the Lancet Diabetes & Endocrinology.
Investigators of the Acarbose Cardiovascular Evaluation randomized clinical trial sought to determine whether acarbose, a diabetes medication, could reduce the risk for MACE and type 2 diabetes in Chinese patients with CHD presenting with glucose intolerance. Participants were randomly assigned to either 50 mg oral acarbose 3 times per day (n=3272) or matched placebo (n=3250).
No significant differences were observed between the treatment and placebo arms with regard to the primary composite outcome of cardiovascular death, admission for unstable angina, admission for heart failure (HF), non-fatal stroke, or non-fatal myocardial infarction (hazard ratio 0.98; 95% CI, 0.86-1.11, P =.73).
Additionally, the researchers observed no differences between the 2 groups with regard to all-cause death, fatal or non-fatal myocardial infarction or stroke, cardiovascular death, hospital admission for unstable angina or HF, or impaired renal function.
Although no significant MACE risk reductions occurred, patients receiving acarbose vs placebo did experience a lower frequency of diabetes (rate ratio 0.82; 95% CI, 0.71-0.94, P =.005). A significantly greater number of patients taking acarbose vs placebo experienced gastrointestinal-related adverse events that caused therapy discontinuation or changes in doses (7% vs 5%, respectively; P =.0007).
There was a decline in therapy adherence over time in this study population, which the investigators suggest may have diminished the potential effects of acarbose. In addition, the researchers note that adding unstable angina and HF hospital admission to the primary composite outcome may have obscured more conclusive cardiovascular events.
In conclusion, the investigators suggest that reducing the risk for diabetes with acarbose may ultimately “help to reduce cardiovascular risk in the longer term by delaying the onset of diabetes in the high-risk population studied.”
Holman RR, Coleman RL, Chan JCN, et al. Effects of acarbose on cardiovascular and diabetes outcomes in patients with coronary heart disease and impaired glucose tolerance (ACE): a randomised, double-blind, placebo-controlled trial. Lancet Diabetes Endocrinol. 2017;5:877-886.