JAMA. 2003 Jul 23;290(4):486-94. Acarbose treatment and the risk of cardiovascular disease and hypertension in patients with impaired glucose tolerance: the STOP-NIDDM trial. Chiasson JL， Josse RG， Gomis R， Hanefeld M， Karasik A， Laakso M; STOP-NIDDM Trial Research Group. Research Centre， Centre Hospitalier de l’Universite de Montreal-Hotel-Dieu and Department of Medicine， Universite de Montreal， Montreal， Quebec， Canada. jean.louis.chiasson@umontreal.ca

CONTEXT: The worldwide explosive increase in type 2 diabetes mellitus and its cardiovascular morbidity are becoming major health concerns.

OBJECTIVE: To evaluate the effect of decreasing postprandial hyperglycemia with acarbose， an alpha-glucosidase inhibitor， on the risk of cardiovascular disease and hypertension in patients with impaired glucose tolerance (IGT).

DESIGN， SETTING， AND PARTICIPANTS: International， multicenter double-blind， placebo-controlled， randomized trial， undertaken in hospitals in Canada， Germany， Austria， Norway， Denmark， Sweden， Finland， Israel， and Spain from July 1998 through August 2001. A total of 1429 patients with IGT were randomized with 61 patients (4%) excluded because they did not have IGT or had no postrandomization data， leaving 1368 patients for a modified intent-to-treat analysis. Both men (49%) and women (51%) participated with a mean (SD) age of 54.5 (7.9) years and body mass index of 30.9 (4.2). These patients were followed up for a mean (SD) of 3.3 (1.2) years. INTERVENTION: Patients with IGT were randomized to receive either placebo (n = 715) or 100 mg of acarbose 3 times a day (n = 714).

MAIN OUTCOME MEASURES: The development of major cardiovascular events (coronary heart disease， cardiovascular death， congestive heart failure， cerebrovascular event， and peripheral vascular disease) and hypertension (> or =140/90 mm Hg).

RESULTS: Three hundred forty-one patients (24%) discontinued their participation prematurely， 211 in the acarbose-treated group and 130 in the placebo group; these patients were also followed up for outcome parameters. Decreasing postprandial hyperglycemia with acarbose was associated with a 49% relative risk reduction in the development of cardiovascular events (hazard ratio [HR]， 0.51; 95% confidence interval [CI]; 0.28-0.95; P =.03) and a 2.5% absolute risk reduction. Among cardiovascular events， the major reduction was in the risk of myocardial infarction (HR， 0.09; 95% CI， 0.01-0.72; P =.02). Acarbose was also associated with a 34% relative risk reduction in the incidence of new cases of hypertension (HR， 0.66; 95% CI， 0.49-0.89; P =.006) and a 5.3% absolute risk reduction. Even after adjusting for major risk factors， the reduction in the risk of cardiovascular events (HR， 0.47; 95% CI， 0.24-0.90; P =.02) and hypertension (HR， 0.62; 95% CI， 0.45-0.86; P =.004) associated with acarbose treatment was still statistically significant.

CONCLUSION: This study suggests that treating IGT patients with acarbose is associated with a significant reduction in the risk of cardiovascular disease and hypertension.