Evaluation of Acarbose in Cardiovascular Disease and Diabetes

Introduction

Medications that effectively address cardiovascular issues and diabetes are vital in modern healthcare. A recent study, known as the ACE Trial, investigated the potential of acarbose to lower the incidence of cardiovascular disease and diabetes among patients.

Significance of the Study

With over 230 million individuals suffering from heart disease in China, the development of effective treatments is critical. Projections indicate that, due to population growth and increased life expectancy, cardiovascular events may rise by 50% between 2010 and 2030.

Acarbose: Mechanism and Purpose

Acarbose is an alpha-glucosidase inhibitor that prevents carbohydrate digestion. The study aimed to explore whether acarbose could decrease the frequency of cardiovascular events in Chinese patients who have established coronary heart disease, impaired glucose tolerance, and type 2 diabetes. This led to the establishment of the Acarbose Cardiovascular Evaluation trial.

About the ACE Trial

Trial Design

The ACE Trial was a randomized, double-blind, phase 4 study that involved Chinese patients aged 50 years or older with coronary heart disease and impaired glucose tolerance. The trial recruited participants from 176 outpatient hospital clinics across China.

Participant Criteria and Treatment

Participants with impaired glucose tolerance, a history of myocardial infarction, unstable angina, or stable angina were randomly assigned to receive either 50 mg of acarbose or a placebo. Before the trial commenced, all participants had taken at least 80% of a placebo medication, ceased other treatments, and received lifestyle guidance regarding diet, exercise, and smoking cessation. Existing cardiovascular therapies, including blood pressure medications, beta blockers, statins, antiplatelet agents, and renin-angiotensin-aldosterone system inhibitors, were adjusted to comply with international treatment guidelines. The trial’s strengths included a substantial participant pool and extended follow-up in this high-risk demographic.

Findings of the Trial

Impact on Cardiovascular Outcomes

Contrary to initial expectations, acarbose did not yield a significant reduction in cardiovascular death, non-fatal myocardial infarction, non-fatal stroke, or hospital admissions due to unstable angina or heart failure.

Effect on Diabetes Incidence

However, acarbose did demonstrate an 18% reduction in the risk of developing diabetes. Researchers suggest that while there was no direct impact on cardiovascular outcomes in the ACE Trial, the possibility of an indirect effect remains a consideration.

Conclusion

The findings of the ACE Trial, published in the journal *Lancet Diabetes Endocrinology*, emphasize the need for further exploration of acarbose’s potential benefits in managing diabetes, even if its direct effects on cardiovascular events were not established.

Reference

Holman, R. R., Coleman, R. L., Chan, J. C. N., et al. Effects of acarbose on cardiovascular and diabetes outcomes in patients with coronary heart disease and impaired glucose tolerance (ACE): a randomized, double-blind, placebo-controlled trial. *Lancet Diabetes Endocrinol*. 2017.