From the Guidelines
Acarbose can be considered appropriate for patients with a history of myocardial infarction (MI), particularly in the context of managing type 2 diabetes or impaired glucose tolerance, as it may offer benefits beyond glycemic control, such as reducing the incidence of diabetes and potentially cardiovascular events. When evaluating the use of acarbose in patients with a history of MI, it's crucial to consider the latest evidence from high-quality studies. The ACE (Acarbose Cardiovascular Evaluation) trial, as mentioned in the 2019 ESC guidelines on diabetes, pre-diabetes, and cardiovascular diseases 1, showed that acarbose did not reduce the risk of major adverse cardiovascular events (MACE) but did reduce the incidence of diabetes by 18% in Chinese patients with coronary artery disease (CAD) and impaired glucose tolerance (IGT).
Key points to consider when prescribing acarbose to patients with a history of MI include:
- Starting with a low dose (25 mg once daily) and gradually increasing as tolerated to minimize gastrointestinal side effects such as flatulence, diarrhea, and abdominal discomfort.
- Monitoring liver function periodically, especially during the first year of treatment, due to the rare risk of hepatotoxicity.
- Recognizing that acarbose has a low risk of hypoglycemia when used as monotherapy, which is beneficial for patients with cardiovascular disease.
- Understanding that while acarbose may not directly reduce the risk of future cardiovascular events, its role in managing glycemic control and potentially reducing the incidence of new-onset diabetes can contribute to overall cardiovascular health.
Given the information from the ACE trial and the context provided by the 2019 ESC guidelines 1, the decision to use acarbose in a patient with a history of MI should be based on individual patient factors, including the presence of diabetes or impaired glucose tolerance, the need for additional glycemic control, and the patient's tolerance of potential side effects. The use of acarbose should be tailored to the specific clinical scenario, prioritizing the reduction of morbidity, mortality, and improvement in quality of life.
From the Research
Acarbose Therapy in Patients with History of Myocardial Infarction (MI)
Acarbose, an alpha-glucosidase inhibitor, has been studied for its efficacy and safety in patients with type 2 diabetes and those with impaired glucose tolerance. The question of whether acarbose is appropriate for a patient with a history of myocardial infarction (MI) can be addressed by examining the available evidence on its cardiovascular benefits and safety profile.
Cardiovascular Benefits
- The study published in 2007 2 highlights the cardiovascular benefits and safety profile of acarbose therapy in patients with prediabetes and established type 2 diabetes, indicating its potential for reducing cardiovascular complications.
- A key study from 2003 3 demonstrates that acarbose treatment is associated with a significant reduction in the risk of cardiovascular disease and hypertension in patients with impaired glucose tolerance, including a reduction in the risk of myocardial infarction.
- These findings suggest that acarbose could be beneficial for patients with a history of MI by reducing the risk of further cardiovascular events.
Safety Profile
- The safety profile of acarbose is characterized by mild-to-moderate gastrointestinal complaints as the most common side-effects, which can be minimized through appropriate dosing regimens and dietary choices 2, 4, 5, 6.
- The majority of the studies indicate that acarbose is well-tolerated and safe for use in patients with type 2 diabetes and those with impaired glucose tolerance, with no significant increase in major adverse cardiovascular events.
Considerations for Patients with History of MI
- While the direct evidence on the use of acarbose specifically in patients with a history of MI is not extensively detailed in the provided studies, the overall cardiovascular benefits and safety profile of acarbose suggest it could be considered as part of the management plan for such patients.
- The decision to use acarbose in a patient with a history of MI should be made on a case-by-case basis, taking into account the patient's overall clinical status, the presence of other cardiovascular risk factors, and the potential for acarbose to contribute to the management of their diabetes and reduction of cardiovascular risk.