Probucol: Can we step forward in atherosclerosis prevention with an old drug?

Abstract

Atherosclerosis is associated with increased inflammation and xidative stress. This leads to the hypothesis that an agent with nti-inflammatory and anti-oxidative activities might have the otential of being athero-protective. Probucol is a di-phenolic ipid-lowering prototype agent with such properties, that might e expected to be useful in atherosclerosis prevention. Since its ntroduction as a cholesterol-lowering drug nearly 40 years ago 1], probucol has received considerable interest, but with mixed cceptance. In addition to many experimental studies, early clinical tudies provided both disappointing and promising results [2–5]. owever, two negative characteristics of probucol, the lowering f high-density lipoprotein cholesterol (HDL-C) and the cardiac lectrophysiological influence of QT prolongation, resulted in its ery limited use in clinical practice. This was also because of he world-wide spread of statin use as a first-line cholesterolowering therapy. As a result, the holders of its patent, Hoechst arion Roussel, decided on the voluntary withdraw of the drug rom the US market in 1995, and after that, the clinical use of robucol has been limited to only a few countries, including apan. In the previous issue of the Journal, the long-term effects of robucol therapy following coronary revascularization have been nvestigated using an observational study design and propensity nalysis [6]. In this study from a single center in Japan, Dr. Kasai nd coworkers collected data from 1694 consecutive patients who nderwent complete revascularization (percutaneous catheter ntervention and/or bypass surgery). Mortality data were compared etween patients who at the time of revascularization were either