Effect of the novel antiplatelet agent cilostazol on plasma lipoproteins in patients with intermittent claudication

Marshall Elam, J. Heckman, J. R. Crouse, D. B. Hunninghake, J. A. Herd, M. Davidson, I. L. Gordon, E. B. Bortey, W. P. Forbes

Research output: Contribution to journalArticle

181 Citations (Scopus)

Abstract

Cilostazol is an antiplatelet agent and vasodilator marketed in Japan for treatment of ischemic symptoms of peripheral vascular disease. It is currently being evaluated in the United States for treatment of symptomatic intermittent claudication (IC). Cilostazol has been shown to improve walking distance in patients with IC. In addition to its reported vasodilator and antiplatelet effects, cilostazol has been proposed to have beneficial effects on plasma lipoproteins. We examined the effect of cilostazol versus placebo on plasma lipoproteins in 189 patients with IC. After 12 weeks of therapy with 100 mg cilostazol BID, plasma triglycerides decreased 15% (P<0.001). Cilostazol also increased plasma high density lipoprotein cholesterol (HDL- C) (10%) and apolipoprotein (apo) A1 (5.7%) significantly (P<0.001 and P<0.01, respectively). Both HDL3 and HDL2 subfractions were increased by cilostazol; however, the greatest percentage increase was observed in HDL2. Individuals with baseline hypertriglyceridemia (> 140 mg/dL) experienced the greatest changes in both HDL-C and triglycerides with cilostazol treatment. In that subset of patients, HDL-C was increased 12.2% and triglycerides were decreased 23%. With cilostazol, there was a trend (3%) toward decreased apoB as well as increased apoA1, resulting in a significant (9.8%, P<0.002) increase in the apoA1 to apoB ratio. Low density lipoprotein cholesterol and lipoprotein(a) concentrations were unaffected. Cilostazol treatment resulted in a 35% increase in treadmill walking time (P=0.0015) and a 9.03% increase in ankle-brachial index (P<0.001). These results indicate that in addition to improving the symptoms of IC, cilostazol also favorably modifies plasma lipoproteins in patients with peripheral arterial disease. The mechanism of this effect is currently unknown.

Original languageEnglish (US)
Pages (from-to)1942-1947
Number of pages6
JournalArteriosclerosis, Thrombosis, and Vascular Biology
Volume18
Issue number12
DOIs
StatePublished - Jan 1 1998

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Intermittent Claudication
Platelet Aggregation Inhibitors
Lipoproteins
Triglycerides
Apolipoproteins B
Vasodilator Agents
Walking
Therapeutics
cilostazol
Ankle Brachial Index
Lipoprotein(a)
Peripheral Vascular Diseases
Peripheral Arterial Disease
LDL Cholesterol
Japan
Placebos

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Effect of the novel antiplatelet agent cilostazol on plasma lipoproteins in patients with intermittent claudication. / Elam, Marshall; Heckman, J.; Crouse, J. R.; Hunninghake, D. B.; Herd, J. A.; Davidson, M.; Gordon, I. L.; Bortey, E. B.; Forbes, W. P.

In: Arteriosclerosis, Thrombosis, and Vascular Biology, Vol. 18, No. 12, 01.01.1998, p. 1942-1947.

Research output: Contribution to journalArticle

Elam, M, Heckman, J, Crouse, JR, Hunninghake, DB, Herd, JA, Davidson, M, Gordon, IL, Bortey, EB & Forbes, WP 1998, 'Effect of the novel antiplatelet agent cilostazol on plasma lipoproteins in patients with intermittent claudication', Arteriosclerosis, Thrombosis, and Vascular Biology, vol. 18, no. 12, pp. 1942-1947. https://doi.org/10.1161/01.ATV.18.12.1942
Elam, Marshall ; Heckman, J. ; Crouse, J. R. ; Hunninghake, D. B. ; Herd, J. A. ; Davidson, M. ; Gordon, I. L. ; Bortey, E. B. ; Forbes, W. P. / Effect of the novel antiplatelet agent cilostazol on plasma lipoproteins in patients with intermittent claudication. In: Arteriosclerosis, Thrombosis, and Vascular Biology. 1998 ; Vol. 18, No. 12. pp. 1942-1947.
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abstract = "Cilostazol is an antiplatelet agent and vasodilator marketed in Japan for treatment of ischemic symptoms of peripheral vascular disease. It is currently being evaluated in the United States for treatment of symptomatic intermittent claudication (IC). Cilostazol has been shown to improve walking distance in patients with IC. In addition to its reported vasodilator and antiplatelet effects, cilostazol has been proposed to have beneficial effects on plasma lipoproteins. We examined the effect of cilostazol versus placebo on plasma lipoproteins in 189 patients with IC. After 12 weeks of therapy with 100 mg cilostazol BID, plasma triglycerides decreased 15{\%} (P<0.001). Cilostazol also increased plasma high density lipoprotein cholesterol (HDL- C) (10{\%}) and apolipoprotein (apo) A1 (5.7{\%}) significantly (P<0.001 and P<0.01, respectively). Both HDL3 and HDL2 subfractions were increased by cilostazol; however, the greatest percentage increase was observed in HDL2. Individuals with baseline hypertriglyceridemia (> 140 mg/dL) experienced the greatest changes in both HDL-C and triglycerides with cilostazol treatment. In that subset of patients, HDL-C was increased 12.2{\%} and triglycerides were decreased 23{\%}. With cilostazol, there was a trend (3{\%}) toward decreased apoB as well as increased apoA1, resulting in a significant (9.8{\%}, P<0.002) increase in the apoA1 to apoB ratio. Low density lipoprotein cholesterol and lipoprotein(a) concentrations were unaffected. Cilostazol treatment resulted in a 35{\%} increase in treadmill walking time (P=0.0015) and a 9.03{\%} increase in ankle-brachial index (P<0.001). These results indicate that in addition to improving the symptoms of IC, cilostazol also favorably modifies plasma lipoproteins in patients with peripheral arterial disease. The mechanism of this effect is currently unknown.",
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