Effect of acarbose on vascular disease in patients with abnormal glucose tolerance.
BACKGROUND
Excessive postprandial (pp) glucose excursion in people with IGT and type 2 diabetes is associated with a cascade of proatherogenic events. Acarbose, a potent competitive inhibitor of alpha-glucosidases of the small intestine specifically reduces pp hyperglycemia with an average reduction of HbA1c by 0.8% in Cochrane metaanalysis. This is associated with pleiotropic effects on a broad spectrum of cardiovascular (CV) risk factors: reduction of overweight, lowering of blood pressure, triglycerides, hsCRP, fibrinogen and other biomarkers of low grade inflammation.


CONCLUSIONS
Flow mediated vasodilation was improved and progression of intima media thickness was reduced by acarbose. In the STOP-NIDDM trial in people with IGT acarbose decreased the incidence of diabetes by 36%. The STOP-NIDDM trial with CV events as secondary objective is the only intervention trial in people with IGT so far with a significant benefit for CV disease inclusive hypertension. In a metaanalysis of controlled studies (MeRIA) in patients with type 2 diabetes, treatment with acarbose was associated with a 64% lower rate of myocardial infarction and 35% less CV events.


CONCLUSIONS
Thus results so far available prove that acarbose is an effective and safe drug to treat abnormal glucose tolerance. They suggest that acarbose can help to control a broad spectrum of CV risk factors and may prevent CV disease.
Hanefeld
Markolf
M
Center for Clinical Studies, GWT-TUD GmbH, Dresden, Germany. hanefeld@gwtonline-zks.de
Schaper
Frank
F
Koehler
Carsta
C
D020909:Acarbose / Q000494:pharmacology / Q000627:therapeutic use*; D000818:Animals; D001808:Blood Vessels / Q000187:drug effects; D002318:Cardiovascular Diseases / Q000139:chemically induced / Q000473:pathology; D003924:Diabetes Mellitus, Type 2 / Q000517:prevention & control; D018149:Glucose Intolerance / Q000150:complications* / Q000188:drug therapy*; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D006943:Hyperglycemia / Q000097:blood / Q000188:drug therapy; D007004:Hypoglycemic Agents / Q000494:pharmacology / Q000627:therapeutic use*; D012307:Risk Factors; D014652:Vascular Diseases / Q000209:etiology* / Q000517:prevention & control*
D020909:Acarbose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents