Effect of cilostazol, a phosphodiesterase‐3 inhibitor, on coronary artery stenosis and plaque characteristics in patients with type 2 diabetes: ESCAPE study

Abstract

Aim: To perform a prospective study to evaluate the effect of cilostazol (CTZ) compared with aspirin (acetylsalicylic acid; ASA) in Korean people with diabetes and subclinical coronary atherosclerosis.Materials and methods: A total of 100 people with diabetes who had mild to moderate coronary atherosclerosis, assessed by coronary computed tomographic angiography (CCTA), were randomly assigned to either 200 mg/d CTZ or 100 mg/d ASA (n = 50 each group). The primary outcome was change in coronary artery stenosis assessed by CCTA after 12 months of treatment. Secondary outcomes included changes in plaque composition, coronary artery calcium score and cardiac markers.Results: The mean age, body mass index and glycated haemoglobin concentration were 61.5 years, 25.0 kg/m 2 and 56.8 mmol/mol, respectively, and were well matched between the two groups. Coronary artery stenosis decreased in the CTZ group (from 44.0 ± 2.1% to 40.4 ± 2.5%) but remained unchanged in the ASA group (from 38.9 ± 2.1% to 40.6 ± 2.1%). In the CTZ group, the non-calcified portion of plaques decreased significantly (from 20.6 ± 3.0 to 17.3 ± 3.0 mm 3 ), whereas it did not change significantly in the ASA group (15.2 ± 2.8 vs 16.6 ± 2.9 mm 3 ). Increases in HDL cholesterol, decreases in triglycerides, liver enzyme and high-sensitivity C-reactive protein levels, and reductions in abdominal visceral fat area and insulin resistance were observed only in the CTZ group.Conclusion: CTZ treatment for 12 months decreased coronary artery stenosis and the noncalcified plaque component. These results suggest that CTZ treatment may be an option for preventing the progression of coronary atherosclerosis in people with diabetes.

Effect of cilostazol on carotid plaque volume measured by three‐dimensional ultrasonography in patients with type 2 diabetes: The FANCY study

“…In the present study, a significant increase in serum HDL cholesterol and a significant decrease in triglyceride levels were observed only in the CTZ group, which was in accordance with the findings of previous studies 23,24,40 . Cilostazol therapy increases lipoprotein lipase activity, which plays a crucial role in lipid metabolism in adipose tissue 22 .…”

“…However, those researchers found that cilostazol therapy increased the fibrous components and decreased the lipid/necrotic components in the carotid plaque. Moreover, we previously published a clinical study in which treatment with cilostazol for 1 year decreased the plaque volume of coronary arteries in patients with T2D (the ESCAPE study) 40 . There were several differences between the ESCAPE and the present study, including the study duration and period and the percentage of patients with comorbidities, such as hypertension and dyslipidaemia.…”

“…Moreover, we previously published a clinical study in which treatment with cilostazol for 1 year decreased the plaque volume of coronary arteries in patients with T2D (the ESCAPE study). 40 There were several differences between the ESCAPE and the present study, including the study duration and period and the percentage of patients with comorbidities, such as hypertension and dyslipidaemia. The relatively short study period of the present study might explain why statistical significance was not reached in the CTZ group.…”

“…In the present study, a significant increase in serum HDL cholesterol and a significant decrease in triglyceride levels were observed only in the CTZ group, which was in accordance with the findings of previous studies. 23,24,40 Cilostazol therapy increases lipoprotein lipase activity, which plays a crucial role in lipid metabolism in adipose tissue. 22 Furthermore, decreasing hepatic triglyceride secretion by potentiating the effect of glucagon to inhibit very-low-density lipoprotein secretion might also contribute to the beneficial effect of cilostazol on lipid metabolism.…”

Cilostazol plus clopidogrel in the prevention of in-stent stenosis after vertebral artery origin stenting in gout patients: three case reports

“…Cilostazol is a phosphodiesterase inhibitor with antiplatelet activity. 8 A previous study demonstrated that the continued use of cilostazol for 12 weeks could lower uric acid levels in patients with impaired glucose tolerance or type 2 diabetes. 9 In addition, cilostazol effectively reduced P2Y12 reaction units in clopidogrel-resistant patients and increased platelet inhibition.…”