Affiliation:
1. From the Department of Internal Medicine and Therapeutics, Osaka University Graduate School of Medicine, Osaka, Japan (N.K., Y.Y.); Department of Internal Medicine, Kyung Hee University College of Medicine, Seoul, Korea (Y.K.); and Department of Medicine, Metabolism, and Endocrinology, Juntendo University School of Medicine, Tokyo, Japan (R.K.).
Abstract
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 carotid intima-media thickening are unknown.
Methods and Results—
To compare prevention by cilostazol and aspirin of progression of atherosclerosis, we conducted a 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 a cilostazol-treated (100 to 200 mg/d) group. The changes in intima-media thickness of the common carotid artery during a 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 A
1c
, the improvements 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.
Clinical Trial Registration—
URL: http://www.clinicaltrials.gov. Unique identifier: C000000215.
Publisher
Ovid Technologies (Wolters Kluwer Health)
Subject
Physiology (medical),Cardiology and Cardiovascular Medicine
Cited by
90 articles.
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