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Type 3 phosphodiesterase inhibitors may be protective against cerebrovascular events in patients with claudication

William M Stone1, Bart M Demaerschalk, Richard J Fowl

  • 1Division of Vascular Surgery, Mayo Clinic College of Medicine, Mayo Clinic Arizona, Phoenix, Arizona 85054, USA. stone.william@mayo.edu

Journal of Stroke and Cerebrovascular Diseases : the Official Journal of National Stroke Association
|April 26, 2008
PubMed

Insights

Patients with peripheral arterial occlusive disease face significant cerebrovascular event risk. Cilostazol, a phosphodiesterase type 3 (PDE3) inhibitor, may reduce this risk, warranting further investigation for stroke prevention.

Area of Science:

  • Cardiovascular Medicine
  • Neurology
  • Pharmacology

Background:

  • Peripheral arterial occlusive disease (PAOD) significantly increases cerebrovascular event risk.
  • Cilostazol, a phosphodiesterase type 3 (PDE3) inhibitor, is used to treat PAOD symptoms.
  • PDE3 inhibitors possess antithrombotic, vasodilatory, and antiproliferative properties.

Purpose of the Study:

  • To evaluate the effect of cilostazol on cerebrovascular events in patients with mild to moderate PAOD.
  • To analyze post hoc data from the Cilostazol: A Study in Long-Term Effects (CASTLE) trial.
  • To assess the safety and efficacy of PDE3 inhibitor use in this patient population.

Main Methods:

  • Prospective, randomized, double-blinded trial (CASTLE) involving 1435 patients.
  • Post hoc analysis focused on cerebrovascular events (stroke, TIA, carotid revascularization).
  • Blinded adjudication of events and Kaplan-Meier analysis for statistical evaluation.

Main Results:

  • Overall cerebrovascular event rate was 4.6% over a mean follow-up of 515 days.
  • Ischemic events (2.5%) were more frequent than hemorrhagic events (0.3%).
  • Cilostazol group showed a lower event rate (3.2%) compared to placebo (6.1%; P < .05).

Conclusions:

  • Patients with mild to moderate PAOD have a notable risk of cerebrovascular events.
  • Treatment with PDE3 inhibitors, such as cilostazol, may reduce this risk.
  • Further research into PDE3 inhibitors for cerebrovascular event prevention is recommended.
Abstract

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