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- July 4, 2008 |
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"Acarbose in the Prevention of Cardiovascular Disease in Subjects with IGT and type 2 diabetes"Prof. Jean-Louis Chiasson (biography)
English - 2005-04-16 - 28 minutes
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Summary :
The STOP-NIDDM Trial investigated the effect of acarbose on the incidence of type 2 diabetes and cardiovascular disease (CVD) in high risk subjects with IGT. Subjects with IGT (n = 1,429) were randomized to either placebo (n = 715) or acarbose (n = 714) 100 mg 3 times a day for a mean follow up time of 3.3 years. The study demonstrated that acarbose treatment resulted in a reduction of diabetes by 36%. Furthermore treatment with acarbose resulted in a significant reduction in the CV events [hazards ratio = 0.51 (95% CI = 0.28-0.95); p = 0.0326], particularly for myocardial infarction [hazards ratio = 0.09 (95% CI = 0.01-0.072); p = 0.0226]. Even after adjusting for major risk factors, acarbose treatment remained effective in reducing the risk of cardiovascular events [hazards ratio = 0.47 (95% CI = 0.25-0.92); p = 0.0246]. A substudy of the STOP-NIDDM trial measuring intima media thickness (IMT) of the common carotid arteries showed that the progression of IMT could be reduced by ~50 % in the acarbose group (p = 0.027). In a meta-analysis on the effect of acarbose on CVD in type 2 diabetic patients, the MeRIA study (acarbose (n = 1248) or placebo (n = 932)) showed that acarbose treatment significantly reduced the incidence of CVD (0.65 [95% CI 0.48-0.88], p = 0.0061). In conclusion, decreasing post-prandial plasma glucose with acarbose was associated with a significant risk reduction for cardiovascular events in subjects with IGT and type 2 diabetes.
Learning objectives :
After viewing this presentation, participants will be able to discuss:
• The rationale for the STOP-NIDDM Trial
• The goals of the STOP-NIDDM Trial
• The effect of acarbose treatment on the risk of progression to diabetes mellitus in patients with IGT
• The effect of acarbose treatment on the risk of cardiovascular events in patients with IGT
• The effect of acarbose treatment on the progression of carotid artery intima-media thickness in patients with IGT
• The effect of acarbose treatment on the risk of cardiovascular events in patients with type 2 diabetes mellitus
Bibliographic references :
The DECODE study group. Glucose tolerance and mortality: comparison of WHO and American Diabetes Association diagnostic criteria. The DECODE study group. European Diabetes Epidemiology Group. Diabetes Epidemiology: Collaborative analysis Of Diagnostic criteria in Europe. Lancet. 1999 Aug 21;354(9179):617-21.
Chiasson JL, Josse RG, Gomis R, Hanefeld M, Karasik A, Laakso M; STOP-NIDDM Trail Research Group. Acarbose for prevention of type 2 diabetes mellitus: the STOP-NIDDM randomised trial. Lancet. 2002 Jun 15;359(9323):2072-7.
Chiasson JL, Josse RG, Gomis R, Hanefeld M, Karasik A, Laakso M; STOP-NIDDM Trial Research Group. Acarbose Treatment and the Risk of Cardiovascular Disease and Hypertension in Patients With Impaired Glucose Tolerance: The STOP-NIDDM Trial JAMA 290:486-494. 2003.
Hanefeld M, Chiasson JL, Koehler C, Henkel E, Schaper F, Temelkova-Kurktschiev T. Acarbose slows progression of intima-media thickness of the carotid arteries in subjects with impaired glucose tolerance. Stroke. 2004 May;35(5):1073-8.
Hanefeld M, Cagatay M, Petrowitsch T, Neuser D, Petzinna D, Rupp M.Acarbose reduces the risk for myocardial infarction in type 2 diabetic patients: meta-analysis of seven long-term studies. Eur Heart J. 2004 Jan;25(1):10-6.
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