Abstract
BackgroundIt has been well established that cilostazol has anti-proliferative effect against in-stent restenosis. However, it remains unclear whether cilostazol can prevent the progression of carotid atherosclerosis. Methods and resultsWe performed a meta-analysis of all relevant randomized controlled trials (RCTs) to evaluate the effect of cilostazol on the progression of carotid intima-media thickness (IMT). Five RCTs with 698 patients [597 subjects with type 2 diabetes mellitus (T2DM)] were included in this study. Cilostazol was associated with a significant reduction in the progression of carotid IMT (WMD, −0.08mm, 95% CI −0.13, −0.04; P=0.00003). Subgroup analysis shows that cilostazol monotherapy or addition to dual antiplatelet therapy (aspirin and clopidogrel) was superior to placebo (WMD, −0.04mm, 95% CI −0.05, −0.03; P<0.00001), no antiplatelet medication (WMD, −0.12mm, 95% CI −0.21, −0.03; P=0.008), aspirin monotherapy (WMD, −0.06mm, 95% CI −0.12, 0.00; P=0.04) or dual antiplatelet therapy (WMD, −0.16mm, 95% CI −0.30, −0.02; P=0.03) in preventing the progression of carotid IMT. Cilostazol resulted in a significant decrease in total cholesterol (WMD −8.47mg/dl, 95% CI −14.18, −2.75; P=0.004) and LDL-C (WMD −8.25mg/dl, 95% CI −14.15, −2.36; P=0.006) and favorable trends in reducing triglyceride (WMD −15.83mg/dl, 95% CI −32.14, 0.48; P=0.06). ConclusionIt suggests that cilostazol may have beneficial effects in preventing the progression of carotid atherosclerosis and improving pro-atherogenic lipid profile, especially in patients with T2DM. Whether the anti-atherosclerotic effect of cilostazol is independent of improving pro-atherogenic dyslipidemia is worth further investigation.
Published Version
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