The phosphodiesterase inhibitor cilostazol induces regression of carotid atherosclerosis in subjects with type2 diabetes mellitus

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 Results from DAPC study

The phosphodiesterase inhibitor cilostazol induces
regression of carotid atherosclerosis in
subjects with type2 diabetes mellitus

Naoto Katakami, MD, PhD; Young-Seol Kim, MD, PhD;
Ryuzo Kawamori, MD, PhD; Yoshimitsu Yamasaki, MD, PhD

Background: Antiplatelet drugs are effective in preventing recurrence of atherosclerosis in type 2 diabetic patients.However, the efficacy and usefulness of 2 different antiplatelet drugs, aspirin and cilostazol, in the progression of carotidintima-media thickening are unknown.

Methods and Results: To compare prevention by cilostazol and aspirin of progression of atherosclerosis, we conducteda prospective, randomized, open, blinded end point study in 4 East Asian countries. A total of 329 type 2 diabetic patients suspected of peripheral artery disease were allocated to either an aspirin-treated (81 to 100 mg/d) group or acilostazol-treated (100 to 200 mg/d) group. The changes in intima-media thickness of the common carotid artery duringa 2-year observation period were examined as the primary end point. The regression in maximum left, maximum right, mean left, and mean right common carotid artery intima-media thickness was significantly greater with cilostazol compared with aspirin (_0.088_0.260 versus 0.059_0.275 mm, P_0.001; _0.042_0.274 versus 0.045_0.216 mm, P_0.003; _0.043_0.182 versus 0.028_0.202 mm, P_0.004; and _0.024_0.182 versus 0.048_0.169 mm, P_0.001). In a regression analysis adjusted for possible confounding factors such as lipid levels and hemoglobin A1c, theimprovements in common carotid artery intima-media thickness with cilostazol treatment over aspirin treatment remained significant.

Conclusions: Compared with aspirin, cilostazol potently inhibited progression of carotid intima-media thickness, an established surrogate marker of cardiovascular events, in patients with type 2 diabetes mellitus.

KEY WORDS: aspirin _ atherosclerosis _ carotid arteries _ diabetes mellitus _ intima-media thickness

Clinical Trial Registration: URL: http://www.clinicaltrials.gov. Unique identifier: C000000215.

(Circulation. 2010;121:2584-2591.)

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