Acarbose Treatment and the Risk of Cardiovascular Disease and Hypertension in Patients With Impaired Glucose Tolerance

Abstract

Context The worldwide explosive increase in type 2 diabetes mellitus and its cardiovascular morbidity are becoming major health concerns. Objective To evaluate the effect of decreasing postprandial hyperglycemia with acarbose, an ␣-glucosidase inhibitor, on the risk of cardiovascular disease and hypertension in patients with impaired glucose tolerance (IGT). Design, Setting, and Participants International, multicenter double-blind, placebocontrolled, randomized trial, undertaken in hospitals in Canada,

Response to Chiasson et al.: Acarbose for the prevention of Type 2 diabetes, hypertension and cardiovascular disease in subjects with impaired glucose tolerance: facts and interpretations concerning the critical analysis of the STOP-NIDDM Trial data

“…In contrast, it confirms most of our objections with regard to the methodology and the results of the STOP-NIDDM Trial [2,3,4,5]. Chiasson et al write: "...for patients with risk of cardiovascular events, the number of patients at risk with acarbose treatment is smaller than the number of patients at risk in the placebo group.…”

“…However, withholding this information in the publication of results [3,4] and declaring that there was no conflict of interest [3] is misleading.In conclusion, both the STOP-NIDDM Trial and the meta-analysis of selected studies with acarbose are seriously flawed and no valid conclusions can be drawn from the published data. …”

“…However, withholding this information in the publication of results [3,4] and declaring that there was no conflict of interest [3] is misleading.…”

“…In addition, the authors report [4] adverse events in all 1429 patients (Tables 2 and 4). We do not understand how the authors were able to assess adverse events in all randomised patients during the course of the trial, but had no chance to document any post-randomisation data on cardiovascular events in at least 61 patients [3].…”

Diabetes, glycaemic control and mortality risk in patients on haemodialysis: the Japan Dialysis Outcomes and Practice Pattern Study

“…There are several possible reasons for the poorer prognosis in those with worse glycaemic control. Several studies have shown an association between stringent glycaemic control and a lowered risk of developing cardiovascular disease and death [30][31][32], but this finding has not been consistent. In our study, patients in the poorer glycaemic control group tended to have a higher frequency of cardiovascular death, although without statistical significance, probably owing to the relatively small sample size.…”