From the Guidelines
Major Adverse Cardiovascular Event (MACE) in the context of diabetes refers to a composite of cardiovascular death, myocardial infarction, or stroke.
Definition of MACE
- MACE is a composite outcome that includes:
- Cardiovascular death
- Myocardial infarction (non-fatal)
- Stroke (non-fatal)
- In some trials, a 4-point MACE is used, which also includes hospitalization for unstable angina 1.
Importance of MACE in Diabetes Management
- MACE is a critical outcome in the management of diabetes, particularly in patients with established atherosclerotic cardiovascular disease (ASCVD) or those at high risk for ASCVD.
- Several studies have demonstrated the effectiveness of certain medications, such as SGLT2 inhibitors and GLP-1 receptor agonists, in reducing the risk of MACE in patients with type 2 diabetes 1.
Examples of MACE Reduction with Medications
- Empagliflozin, an SGLT2 inhibitor, has been shown to decrease the risk of MACE in patients with established ASCVD 1.
- Liraglutide, a GLP-1 receptor agonist, has been shown to reduce the risk of MACE by 13% compared to placebo in the LEADER trial 1.
- Dulaglutide, another GLP-1 receptor agonist, has been shown to reduce the risk of MACE by 12% compared to placebo in a recent trial 1.
From the Research
Definition of Major Adverse Cardiovascular Event (MACE)
- MACE is a composite endpoint used to measure cardiovascular outcomes in clinical trials, particularly in the context of diabetes 2, 3, 4, 5, 6.
- The traditional definition of MACE includes nonfatal myocardial infarction (MI), nonfatal stroke, and cardiovascular death 3.
- Some studies also include hospitalization for unstable angina (HUA) as a component of MACE, referred to as 4P-MACE 3.
- More recently, hospitalization for heart failure (HHF) has been added to the definition of MACE, resulting in 5P-MACE 2.
Components of MACE
- Nonfatal MI: a heart attack that does not result in death 3, 4, 5, 6.
- Nonfatal stroke: a stroke that does not result in death 3, 4, 5, 6.
- Cardiovascular death: death due to cardiovascular causes 3, 4, 5, 6.
- Unstable angina: a condition characterized by chest pain or discomfort due to reduced blood flow to the heart 3.
- Hospitalization for heart failure: hospitalization due to heart failure, which can be a complication of diabetes and cardiovascular disease 2.
Importance of MACE in Diabetes
- Diabetes is a major risk factor for cardiovascular disease, and MACE is a common outcome in patients with diabetes 2, 3, 4, 5, 6.
- Reducing the risk of MACE is a key goal of treatment in patients with diabetes, and can be achieved through lifestyle modifications, glucose-lowering medications, and other interventions 5, 6.
- MACE can be used as a surrogate endpoint for cardiovascular mortality, allowing for the evaluation of treatment effects on cardiovascular outcomes in clinical trials 2.
Expansion of MACE to Include Peripheral Artery Disease (PAD)
- PAD is a common complication of diabetes, and can contribute to significant morbidity and mortality 2.
- Including PAD in the definition of MACE can provide a more comprehensive assessment of cardiovascular risk in patients with diabetes 2.
- PAD outcomes, such as lower extremity amputation, can be objectively measured and improved with treatment, including intensive glycemic control and novel oral anticoagulants 2.