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(Stroke. 2004;35:1073.)
© 2004 American Heart Association, Inc.

Original Contributions

Acarbose Slows Progression of Intima-Media Thickness of the Carotid Arteries in Subjects With Impaired Glucose Tolerance

Markolf Hanefeld, PhD; Jean Louis Chiasson, PhD; Carsta Koehler, PhD; Elena Henkel, MD; Frank Schaper, MD Theodora Temelkova-Kurktschiev, PhD

From the Centre for Clinical Studies (M.H, C.K., E.H., T.T.-K.) and Institute and Outpatient Department for Clinical Metabolic Research (F.S.), Dresden Technical University, Dresden, Germany; Research Centre-CHUM-Hotel-Dieu (J.L.C.), Montreal, Canada.

Correspondence to Prof M. Hanefeld, Zentrum für Klinische Studien GWT der Technischen Universität Dresden, Fiedlerstr. 34, 01307 Dresden, Germany. E-mail hanefeld{at}gwt-tud.de

Background and Purpose— Impaired glucose tolerance (IGT)–a prediabetic state–is an important risk factor for atherosclerosis. Acarbose, an -glucosidase inhibitor, was shown in the placebo-controlled prospective study to prevent noninsulin-dependent diabetes mellitus (STOP-NIDDM) trial to reduce the risk of diabetes by 36% in IGT subjects. This article reports on a placebo-controlled subgroup analysis of the STOP-NIDDM study to examine the efficacy of acarbose to slow progression of intima-media thickness (IMT) in subjects with IGT.

Methods— One hundred thirty-two IGT subjects were randomized to placebo (n=66) or acarbose (n=66) 100 mg 3 times daily; the study duration was at least 3 years, mean follow-up time 3.9 (SD 0.6) years. Carotid IMT was determined at study entry and the end of the trial. The intent-to-treat analysis included 56 subjects in the acarbose and 59 in the control group who had a baseline and endpoint measurement.

Results— A significant reduction of the progression of IMT_mean was observed in the acarbose group versus placebo. After an average time of 3.9 years, IMT_mean increased by 0.02 (0.07) mm in the acarbose group versus 0.05 (0.06) mm in the placebo group (P=0.027). The annual increase of IMT_mean was reduced by 50% in the acarbose group versus placebo. Multiple linear regression revealed IMT progression as significantly related to acarbose intake.

Conclusions— Acarbose slows progression of IMT in IGT subjects, a high-risk population for diabetes and atherosclerosis. This is the first placebo-controlled prospective subgroup analysis, demonstrating that counterbalancing of postprandial hyperglycemia may be vasoprotective.

Key Words: acarbose • glucose intolerance • intima-media thickness • hyperglycemia • ultrasonography

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