Effect of acarbose treatment on the risk of silent myocardial infarctions in patients with impaired glucose tolerance: results of the randomised STOP-NIDDM trial electrocardiography substudy.

BACKGROUND: The moderate increase in postprandial plasma glucose in subjects with impaired glucose tolerance has been shown to be a predictor of cardiovascular disease. In the randomised STOP-NIDDM trial, we could demonstrate that lowering postprandial plasma glucose with acarbose in subjects with impaired oral glucose tolerance could reduce the risk of diabetes. METHODS: The current report focuses on the effect of acarbose on silent ischaemic events evaluated in the electrocardiographic substudy, using the Minnesota code classification. RESULTS: A total of 1181 patients were included in the ECG substudy. From these 72 patients had significant changes between the baseline and end of treatment ECG, 33 in the acarbose and 39 in the placebo group. Higher rates of myocardial infarctions occurred in the placebo group (P=0.07 with Fisher's Exact test and P=0.023 with Chi-square test), while there were no differences between the two groups with ECG changes classified under the other Minnesota codes. CONCLUSIONS: In this prospective intervention study we could show that acarbose, by decreasing postprandial hyperglycaemia, can reduce the incidence of silent myocardial infarctions in subjects with impaired glucose tolerance. This approach should therefore be evaluated in other higher risk populations.