ACE results suggest no reduction in CV risk with acarbose treatment
medwireNews: The α-glucosidase inhibitor acarbose does not reduce cardiovascular (CV) risk but could decrease the risk for developing type 2 diabetes among patients with coronary heart disease and impaired glucose tolerance, results of the phase IV placebo-controlled ACE trial suggest.
As presented by the investigators at the EASD annual meeting in Lisbon, Portugal, and published simultaneously in The Lancet Diabetes & Endocrinology, the ACE (Acarbose Cardiovascular Evaluation) investigators, led by Rury Holman (University of Oxford, UK), randomly assigned 6522 Chinese patients to receive treatment with either acarbose 50 mg three times daily or placebo, in addition to standardized secondary prevention therapy.
The team found that 14.4% of 3272 patients in the acarbose group experienced the primary cardiovascular endpoint – a composite of cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, hospital admission for unstable angina, and hospital admission for heart failure – over a median follow-up of 5.0 years, compared with 14.7% of 3250 participants in the placebo group, giving a nonsignificant hazard ratio of 0.98.
“In other words, acarbose did not have any effect on the composite cardiovascular outcome,” investigator John McMurray (University of Glasgow, UK) told delegates at the EASD meeting.
Similarly, there was no significant difference in the incidence of the secondary composite outcome of cardiovascular death, nonfatal myocardial infarction, and nonfatal stroke among patients receiving acarbose compared with placebo (8.7 vs 9.2%), and rates of all-cause mortality were comparable in the two groups (6.6 vs 6.7%).
However, the team found that patients treated with acarbose were significantly less likely to develop type 2 diabetes than those in the placebo group, with rates of 13.3% versus 15.8% (rate ratio=0.82).
We have two studies showing that [acarbose] can help prevent diabetes; perhaps there’s where we need to begin using acarbose more regularly
“These results extend the knowledge of the safety of acarbose and its efficacy for delaying the onset of diabetes to a population with both coronary heart disease and impaired glucose tolerance,” said Holman, speculating that this could “help to reduce cardiovascular risk in the longer term by delaying the onset of diabetes in the high-risk population studied, as was seen in the 23-year follow-up of the Da Qing study.”
And in her commentary on the study, Chantal Mathieu (Katholieke Universiteit Leuven, Belgium) highlighted that although the ACE trial showed no effect of acarbose on the five-point composite cardiovascular endpoint, it was a “very well-designed, very well-powered study” showing that the drug is efficacious in preventing type 2 diabetes in an Asian population.
“Is the prevention of diabetes by itself not fantastic?” she said.
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