Cilostazol in the Management of Atherosclerosis

Abstract

The burden of atherosclerosis is particularly high in western countries in terms of mortality and disability. The cerebral arteries (stroke or transient ischemic attack [TIA]), coronary arteries (myocardial infarction [MI]) and peripheral arteries (intermittent claudication [IC], ischemic limb) can be affected. Atherosclerosis may involve different mechanisms such as inflammation, platelet activation, endothelial damage, balance between proliferation and apoptosis of smooth muscle cells and oxidative stress. Research is focused to counteract each of these aspects. Many antithrombotic drugs are currently available and most of them act as inhibitors of platelet function. Aspirin, ticlopidine, clopidogrel and the combination of aspirin plus dipyridamole are widely used for primary (in high-risk patients) and secondary prevention of atherosclerotic diseases. Research of new pharmacological strategies is driven by the need to reduce the risk of bleeding associated with the use of antiplatelet drugs. In this context cilostazol, a type III phosphodiesterase inhibitor, has demonstrated antiplatelet and vasodilator effects with low rate of bleeding complications. This review will focus on the pharmacological properties of cilostazol and its use in the management of atherothrombotic vascular diseases.

RETRACTED ARTICLE: Systematic study of cilostazol on secondary stroke prevention: a meta-analysis

“…Therefore, its prevention can reduce the risk of ischemic stroke. A randomized study of 135 patients with symptomatic intracranial arterial stenosis showed that treatment with cilostazol significantly reduced progression of the stenosis [31]. Moreover, cilostazol also significantly prevented progression of carotid artery intima-media thickness [32], which is an indicator of atherosclerosis and an established risk factor for stroke [33,34].…”

Cilostazol Prevents Endothelin-Induced Smooth Muscle Constriction and Proliferation

“…Although cilostazol is FDA-approved agent for treating intermittent claudication, it has been suggested that cilostazol can treat other cardiovascular diseases. Based on its vasodilation activity, for example, cilostazol has been proposed to be a possible regimen for patients with congestive heart failure, ischemic stroke, post-stent thrombosis, and other atherothrombotic vascular diseases [1], [2]. Based on its anti-proliferation activity, cilostazol has also been suggested to reduce cardiac hypertrophy and attenuate the overall cardiac remodeling [22].…”

“…Cilostazol is a selective inhibitor of type-3 phosphodiesterase (PDE), and it is currently used to treat peripheral vascular disease of intermittent claudication [1], [2]. Thus, the clinical benefit of cilostazol is primarily set on its mechanism of action in preventing activation or aggregation of platelets.…”

Stroke Prevention: Managing Modifiable Risk Factors

“…Cilostazol is a selective and potent selective type III phosphodiesterase (PDE 3A) inhibitor, leading to inhibition of platelet aggregation and vasodilation, with potential use in atherosclerotic conditions, including stroke [79, 80]. The Cilostazol Stroke Prevention Study (CSPS) [81, 82] was designed to evaluate safety and effectiveness of cilostazol in prevention recurrent stroke.…”