Effect of cilostazol, a phosphodiesterase‐3 inhibitor, on coronary artery stenosis and plaque characteristics in patients with type 2 diabetes: ESCAPE study

Aim To perform a prospective study to evaluate the effect of cilostazol (CTZ) compared with aspirin (acetylsalicylic acid; ASA) in Korean people with diabetes and subclinical coronary atherosclerosis. Materials and methods A total of 100 people with diabetes who had mild to moderate coronary atherosclerosis, assessed by coronary computed tomographic angiography (CCTA), were randomly assigned to either 200 mg/d CTZ or 100 mg/d ASA (n = 50 each group). The primary outcome was change in coronary artery stenosis assessed by CCTA after 12 months of treatment. Secondary outcomes included changes in plaque composition, coronary artery calcium score and cardiac markers. Results The mean age, body mass index and glycated haemoglobin concentration were 61.5 years, 25.0 kg/m 2 and 56.8 mmol/mol, respectively, and were well matched between the two groups. Coronary artery stenosis decreased in the CTZ group (from 44.0 ± 2.1% to 40.4 ± 2.5%) but remained unchanged in the ASA group (from 38.9 ± 2.1% to 40.6 ± 2.1%). In the CTZ group, the non‐calcified portion of plaques decreased significantly (from 20.6 ± 3.0 to 17.3 ± 3.0 mm 3 ), whereas it did not change significantly in the ASA group (15.2 ± 2.8 vs 16.6 ± 2.9 mm 3 ). Increases in HDL cholesterol, decreases in triglycerides, liver enzyme and high‐sensitivity C‐reactive protein levels, and reductions in abdominal visceral fat area and insulin resistance were observed only in the CTZ group. Conclusion CTZ treatment for 12 months decreased coronary artery stenosis and the non‐calcified plaque component. These results suggest that CTZ treatment may be an option for preventing the progression of coronary atherosclerosis in people with diabetes.