3P-MACE: 3-point major adverse cardiac events

3P-MACE: 3-point major adverse cardiac events

3P-MACE: 3-point major adverse cardiac event comprises of cardiovascular (CV) death, nonfatal myocardial infarction (MI) or nonfatal stroke. It is now an important primary endpoint for cardiovascular outcome trials. From 2008, United States Food and Drug Administration (US FDA) has made cardiovascular outcome trials mandatory for all new anti diabetic medications [1]. This was because of the perceived cardiovascular risk of certain oral hypoglycemic agents in the past. Moreover, reduction of HbA1c by itself did not significantly reduce cardiovascular risk or mortality.

Some studies have included hospitalization for unstable angina along with this and checked 4P-MACE. But inclusion of hospitalization for unstable angina introduces a disadvantage of clinical subjectivity in the assessment of unstable angina. There is also a lower prognostic significance compared to the other components like CV death, MI or stroke. Moreover, recent cardiovascular outcome trials also indicate minimal impact of glucose lowering agents in hospitalization for unstable angina. Hence the inclusion unstable angina in the primary endpoint has been questioned by some authors [2].

References

1. Wilcox T, De Block C, Schwartzbard AZ, Newman JD. Diabetic Agents, From Metformin to SGLT2 Inhibitors and GLP1 Receptor Agonists: JACC Focus Seminar. J Am Coll Cardiol. 2020 Apr 28;75(16):1956-1974.
2. Marx N, McGuire DK, Perkovic V, Woerle Hj, Broedl UC, von Eynatten M, George JT, Rosenstock J. Composite Primary End Points in Cardiovascular Outcomes Trials Involving Type 2 Diabetes Patients: Should Unstable Angina Be Included in the Primary End Point? Diabetes Care. 2017 Sep;40(9):1144-1151.