Effect of Probucol and/or Cilostazol on Carotid Intima Media Thickness in Patients with Coronary Heart Disease : A Randomized, Multicenter, Multinational Study

[Aim] : In a prospective randomized multinational open blinded endpoint study, the long-term effects of probucol or probucol and cilostazol with statin on carotid mean intima media thickness (IMT) were evaluated for the first time. [Methods] : Hypercholesterolemic patients with coronary artery disease were randomized to three groups and received study drugs for 3 years : the control with statin alone ; the probucol group with statin and probucol ; and the combo group with statin, probucol, and cilostazol. Primary efficacy endpoint was changes of mean carotid IMT at 3 years. Biomarkers, major adverse cerebro-cardiovascular events (MACCEs) and safety were secondary endpoints. [Results] : Two hundred eighty-one patients were randomized into three groups. All three groups showed significant regression of carotid IMT at 3 years compared with baseline. Decrease in mean carotid IMT was significantly greater in the combo group than in the control group at 1 year. However, there were no significant differences in changes of mean carotid IMT between groups at 3 years (control ; -0.12 +- 0.36 mm vs. probucol ; -0.11 +- 0.32 mm vs. combo ; -0.16 +- 0.38 mm). MACCEs were frequent in the control group, but the difference was not significant (control ; 10.8% vs. probucol ; 4.4% vs. combo ; 6.9%, p=0.35). Probucol and cilostazol were well tolerated in long-term treatment without serious drug-related adverse reactions. [Conclusion] : Probucol or probucol and cilostazol with statin did not reduce carotid IMT in comparison with statin alone in this study. However, the clinical outcome of probucol-based treatment with current standard statin treatment may need further studies.