Abstract 735: Miglitol, an Alpha-glucosidase Inhibitor, Protects Against Myocardial Ischemia Independent of Blood Glucose Level in Diabetic Patients With Coronary Artery Disease
Background: We previously reported that miglitol, an alpha-glucosidase inhibitor, has a cardioprotective effects in animal models of myocardial infarction and angina pectoris. This study investigated whether miglitol improves myocardial ischemia assessed by exercise thallium(Tl)-201 myocardial single photon emission computed tomography (SPECT) in diabetic patients with coronary artery disease.
Subjects and Methods: Nineteen type 2 diabetic patients (mean HbA1c 7.3%) with coronary stenosis diagnosed by coronary angiography and showing ischemic areas by exercise Tl-201 myocardial SPECT, were randomly assigned to 2 groups. Patients already taking an alpha-glucosidase inhibitor were excluded. The miglitol group patients (n=10) were treated with miglitol (150mg/day) and baseline medications. The control group patients (n=9) were treated with baseline medications alone. Exercise Tl-201 myocardial SPECT performed before treatment and 10 weeks after treatment were compared to assess levels of myocardial ischemia. Summed stress score (SSS), summed rest score (SRS) and summed difference score (SDS) were calculated using a 5-point scoring (Normal: 0, No uptake: 4) in a 17-segment model.
Results: HbA1c changed from 7.4±1.3% to 7.2±0.8% in the miglitol group and from 7.0±1.0% to 7.1±1.0% in the control group. Double-product as a level of exercise before and after treatment in exercise Tl-201 myocardial SPECT did not differ in either group. A significant improvement in SSS was observed in the miglitol group (from 12.6±11.4 to 9.6±10.7, p<0.05) but not in the control group (from 11.8±11.5% to 11.8±13.1). No significant change occurred in SRS for either group. A significant improvement in SDS was observed in the miglitol group (from 5.5±2.4 to 3.7±3.3, p<0.05) but not in the control group (from 5.1±3.9 to 4.4±5.2). The improvement of SSS and SDS had no apparent correlation with the change in HbA1c level.
Conclusion: Miglitol treatment improves myocardial ischemia independently of the effect on blood glucose level. This suggests that miglitol treatment may be a novel therapeutic strategy for treating diabetic patients with coronary artery disease.