Acarbose in the prevention of cardiovascular disease in subjects with impaired glucose tolerance and    type 2 diabetes mellitus

    The prevalence of glucose intolerance is increasing dramatically worldwide. Both impaired glucose tolerance (IGT) and type 2 diabetes are associated with excess mortality from cardiovascular disease. It is now generally accepted that these cardiovascular complications are related to prevailing hyperglycemia, particularly postprandial hyperglycemia. Acarbose  specifically decreases the postprandial glycemic surge in IGT and diabetic subjects. The Study  To  Prevent  Non-insulin-dependent Diabetes Mellitus (STOP-NIDDM) trial has shown that acarbose treatment in IGT subjects decreased the risk of   progression to diabetes by 36%. Furthermore, it was associated with a 49% risk reduction of cardiovascular events. In a  subgroup of subjects, acarbose treatment was accompanied by a 50% decrease in the progression of intima-media thickness  of the carotids. Finally, a meta-analysis of seven major studies on the use of acarbose in the treatment of diabetes      indicated that acarbose treatment was associated with a 35% risk reduction of cardiovascular disease. It is proposed that the mechanism by which acarbose can lower the risk of cardiovascular events is through diminution of oxidative stress   induced by postprandial glycemic excursion.