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Cardiovascular risk associated with acarbose versus metformin as the first-line treatment in patients with type 2 diabetes: a nationwide cohort study.
J Clin Endocrinol Metab. 2015 Mar; 100(3):1121-9.JC

Abstract

CONTEXT

Metformin is the first-line oral therapy for type 2 diabetes with proven benefits against cardiovascular risk. Recent evidence suggested that acarbose might be similar to metformin in glucose-lowering efficacy and cardiovascular risk reduction. Therefore, international guidelines have suggested the use of acarbose as alternative first-line antidiabetic therapy.

OBJECTIVE

To compare the cardiovascular outcomes in the first-line users of acarbose vs metformin. DESIGN, SETTING, PATIENTS, AND OUTCOME MEASURES: A nationwide cohort study was conducted by analyzing the Taiwan National Health Insurance (NHI) Database. A total of 17,366 acarbose initiators and 230,023 metformin initiators were identified between January 1, 2009 and December 31, 2010. The primary outcome is hospitalization due to any cardiovascular events, including acute myocardial infarction, congestive heart failure, and ischemic stroke. The propensity score method was used to adjust for baseline differences between the two groups. Patients were followed from drug initiation to the earliest of outcome occurrence, death or disenrollment from NHI, or study termination.

RESULTS

In intention-to-treat analyses, acarbose was associated with a higher risk of any cardiovascular event (adjusted hazard ratio [HR]: 1.05; 95% confidence interval [CI], 1.01-1.09), heart failure (HR, 1.08; 95% CI, 1.00-1.16), and ischemic stroke (HR, 1.05, 95% CI, 1.00-1.10) than metformin. No significant difference in risk was found in subgroups of patients with or without underlying hypertension, ischemic heart disease, or cerebrovascular disease. Similar results were found in auxiliary as-treated analyses or analyses stratified by propensity score quintiles.

CONCLUSION

Our data do not support that acarbose has a cardio-protective effect similar to metformin as a first-line antidiabetic agent.

Authors+Show Affiliations

Institute of Preventive Medicine (C-H.C., S-T.C., L-M.C., M-S.L.), College of Public Health, National Taiwan University, Taipei, Taiwan; Department of Internal Medicine (C-H.C., L-M.C.), Graduate Institute of Medical Genomics and Proteomics (Y-C.C.), National Taiwan University, Taipei, Taiwan; National Taiwan University Hospital, Taipei, Taiwan; Department of Medicine (C-H.C., Y-C.C., J-W.L., L-M.C.), College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Internal Medicine (Y-C.C.), National Taiwan University Hospital, Hsin Chu Branch, HsinChu, Taiwan; Cardiovascular Center (J-W.L.), National Taiwan University Hospital, Yun-Lin Branch, Dou-Liou City, Yun-Lin County, Taiwan.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

25555040

Citation

Chang, Chia-Hsuin, et al. "Cardiovascular Risk Associated With Acarbose Versus Metformin as the First-line Treatment in Patients With Type 2 Diabetes: a Nationwide Cohort Study." The Journal of Clinical Endocrinology and Metabolism, vol. 100, no. 3, 2015, pp. 1121-9.
Chang CH, Chang YC, Lin JW, et al. Cardiovascular risk associated with acarbose versus metformin as the first-line treatment in patients with type 2 diabetes: a nationwide cohort study. J Clin Endocrinol Metab. 2015;100(3):1121-9.
Chang, C. H., Chang, Y. C., Lin, J. W., Chen, S. T., Chuang, L. M., & Lai, M. S. (2015). Cardiovascular risk associated with acarbose versus metformin as the first-line treatment in patients with type 2 diabetes: a nationwide cohort study. The Journal of Clinical Endocrinology and Metabolism, 100(3), 1121-9. https://doi.org/10.1210/jc.2014-2443
Chang CH, et al. Cardiovascular Risk Associated With Acarbose Versus Metformin as the First-line Treatment in Patients With Type 2 Diabetes: a Nationwide Cohort Study. J Clin Endocrinol Metab. 2015;100(3):1121-9. PubMed PMID: 25555040.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cardiovascular risk associated with acarbose versus metformin as the first-line treatment in patients with type 2 diabetes: a nationwide cohort study. AU - Chang,Chia-Hsuin, AU - Chang,Yi-Cheng, AU - Lin,Jou-Wei, AU - Chen,Shu-Ting, AU - Chuang,Lee-Ming, AU - Lai,Mei-Shu, Y1 - 2015/01/02/ PY - 2015/1/3/entrez PY - 2015/1/3/pubmed PY - 2015/5/13/medline SP - 1121 EP - 9 JF - The Journal of clinical endocrinology and metabolism JO - J Clin Endocrinol Metab VL - 100 IS - 3 N2 - CONTEXT: Metformin is the first-line oral therapy for type 2 diabetes with proven benefits against cardiovascular risk. Recent evidence suggested that acarbose might be similar to metformin in glucose-lowering efficacy and cardiovascular risk reduction. Therefore, international guidelines have suggested the use of acarbose as alternative first-line antidiabetic therapy. OBJECTIVE: To compare the cardiovascular outcomes in the first-line users of acarbose vs metformin. DESIGN, SETTING, PATIENTS, AND OUTCOME MEASURES: A nationwide cohort study was conducted by analyzing the Taiwan National Health Insurance (NHI) Database. A total of 17,366 acarbose initiators and 230,023 metformin initiators were identified between January 1, 2009 and December 31, 2010. The primary outcome is hospitalization due to any cardiovascular events, including acute myocardial infarction, congestive heart failure, and ischemic stroke. The propensity score method was used to adjust for baseline differences between the two groups. Patients were followed from drug initiation to the earliest of outcome occurrence, death or disenrollment from NHI, or study termination. RESULTS: In intention-to-treat analyses, acarbose was associated with a higher risk of any cardiovascular event (adjusted hazard ratio [HR]: 1.05; 95% confidence interval [CI], 1.01-1.09), heart failure (HR, 1.08; 95% CI, 1.00-1.16), and ischemic stroke (HR, 1.05, 95% CI, 1.00-1.10) than metformin. No significant difference in risk was found in subgroups of patients with or without underlying hypertension, ischemic heart disease, or cerebrovascular disease. Similar results were found in auxiliary as-treated analyses or analyses stratified by propensity score quintiles. CONCLUSION: Our data do not support that acarbose has a cardio-protective effect similar to metformin as a first-line antidiabetic agent. SN - 1945-7197 UR - https://www.unboundmedicine.com/medline/citation/25555040/Cardiovascular_risk_associated_with_acarbose_versus_metformin_as_the_first_line_treatment_in_patients_with_type_2_diabetes:_a_nationwide_cohort_study_ L2 - https://academic.oup.com/jcem/article-lookup/doi/10.1210/jc.2014-2443 DB - PRIME DP - Unbound Medicine ER -