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Higher CV risk with acarbose than metformin in type 2 diabetes
In patients with type 2 diabetes, an initial regimen of acarbose therapy was associated with a moderately higher risk for cardiovascular disease compared with metformin therapy, according to recent findings.
In the nationwide cohort study, Lee-Ming Chuang, MD, PhD, of Nationwide Taiwan University Hospital, and colleagues evaluated data from the Taiwan National Health Insurance Database. The database includes information on outpatient visits, hospital admissions, prescriptions, disease and deaths for 99% of the population of Taiwan.
From these records, the researchers identified adult patients with type 2 diabetes who began treatment with oral antidiabetic agents between Jan. 1, 2009, and Dec. 31, 2010. Participants included in the analysis underwent treatment either with acarbose monotherapy (n = 17,366) or metformin monotherapy (n = 230,023). Follow-up occurred from the study’s index date to date of outcome occurrence, disenrollment from Taiwan National Health Insurance, death or Dec. 31, 2011.
The researchers defined the study’s primary outcome as first hospital admission for any cardiovascular event, including acute myocardial infarction, congestive heart failure and ischemic stroke. The secondary outcomes were the first hospitalization for three individual cardiovascular events.
Intention-to-treat analyses revealed an association between acarbose monotherapy and increased risk for any cardiovascular event (adjusted HR = 1.05; 95% CI, 1.01-1.09), heart failure (HR = 1.08; 95% CI, 1-1.16) and ischemic stroke (HR = 1.05; 95% CI, 1-1.1). Subgroup analyses showed no significant difference in risk between patients with or without underlying hypertension, ischemic heart disease or cerebrovascular disease in either the intention-to-treat or as-treated approaches. Analyses stratified by propensity score quintiles demonstrated similar results.
“In summary, we found that initial acarbose therapy in type 2 diabetic patients was associated with a modestly higher risk of cardiovascular diseases, including [congestive heart failure] and ischemic stroke, than metformin therapy,” the researchers wrote. “The risks remained significant after adjustment for potential confounding factors. Although our data support metformin but not acarbose as a first-line oral antidiabetic agent for type 2 diabetes with favorable cardiovascular effects, further randomized clinical trials are needed to compare their long-term effects.” – by Jennifer Byrne
Disclosure: The researchers report no relevant financial disclosures.