Cilostazol treatment for preventing adverse cardiovascular events in patients with type 2 diabetes and coronary atherosclerosis: Long‐term follow‐up of the ESCAPE study

BACKGROUND: Previously, in the ESCAPE study, a randomized controlled trial, we found that 12 months of cilostazol administration significantly decreased coronary artery stenosis and the noncalcified plaque component compared with aspirin. The goal of the current study was to evaluate the effect of cilostazol treatment on cardiovascular events up to 7 years after the end of the original study. METHODS: After the end of the ESCAPE study with patients with type 2 diabetes mellitus (T2DM) and mild to moderate coronary artery stenosis, we decided to extend the ESCAPE study to investigate the long‐term effect of cilostazol and aspirin, named the ESCAPE‐extension study. The study participants had been investigated for cardiovascular events for up to 7 years, bringing the total follow‐up time to a median of 5.2 years (interquartile range 3.6‐6.7 years). Adverse events were also investigated. RESULTS: Among 100 participants from the original study, 88 were included in this extension study. Cilostazol treatment reduced the incidence of cardiovascular events in the patients with T2DM when compared with aspirin for a 5.2‐year median follow‐up (hazard ratio 0.24; 95% CI, 0.07‐0.83). The cardiovascular benefit of cilostazol therapy was maintained along with age, sex, systolic blood pressure, low‐density lipoprotein cholesterol, and coronary artery calcium score. No serious adverse events in the cilostazol group were noted in the follow‐up period. CONCLUSIONS: In this ESCAPE‐extension study, cilostazol treatment proved its efficacy in reducing cardiovascular events compared with aspirin in diabetic patients with subclinical coronary artery disease, suggesting the beneficial role of cilostazol in the primary prevention of cardiovascular disease.