Efficacy and Safety of Cilostazol for Atherosclerosis: A Meta-analysis of Randomized Controlled Trials

To investigate the efficacy and safety of cilostazol for atherosclerosis. PubMed, Embase, and the Cochrane Central Register of Controlled Trials from inception to May 29, 2021, were searched for randomized clinical trials (RCTs). Ten trials with 1577 patients were included. Treatment with cilostazol significantly reduced carotid intima-media thickness [mean difference (MD), -0.12 mm; 95% confidence interval (CI), -0.17 to -0.06]. According to the difference in intervening measures, the cilostazol group was superior to the control group in inhibiting the progression of carotid intima-media thickness: cilostazol versus placebo (MD, -0.04 mm; 95% CI, -0.06 to -0.02; P < 0.00001), cilostazol versus no antiplatelet drug (MD, -0.14 mm; 95% CI, -0.26 to -0.03; P = 0.02), cilostazol versus aspirin (MD, -0.17 mm; 95% CI, -0.32 to -0.02; P = 0.02), cilostazol + aspirin versus aspirin (MD, -0.08 mm; 95% CI, -0.14 to -0.02; P = 0.007), cilostazol + aspirin versus clopidogrel + aspirin (MD, -0.07 mm; 95% CI, -0.14 to -0.00; P = 0.04), and cilostazol + clopidogrel + aspirin versus clopidogrel + aspirin (MD, -0.16 mm; 95% CI, -0.30 to -0.02; P = 0.03). Cilostazol treatment considerably decreased triglyceride (MD, -20.18 mg/dL; 95% CI, -39.03 to -1.34) and improved high-density lipoprotein cholesterol (MD, 4.35 mg/dL; 95% CI, 2.61-6.10). Cilostazol therapy significantly increased the risk of adverse events of headache (odds ratio, 12.91; 95% CI 5.33-31.29). Our research has revealed that cilostazol has potent antiatherosclerotic effects and can reverse atherosclerosis progress even in high-risk patients, such as those with type 2 diabetes mellitus, and does not increase the risk of bleeding.