Use of Platelet Inhibitor Cilostazol To Treat Vasospastic Angina Interview with:
Professor June-Hong Kim, Division of Cardiology
Department of Internal Medicine and Research Institute for Convergence of Biomedical Science and Technology,
Pusan National University Yangsan Hospital
Yangsan, South Korea;

MedicalResearch: What are the main findings of the study?

Dr. Kim: In vasospastic angina, the cilostazol group significantly reduced relative ireduction of of weekly incidence of chest pain compared with placebo group (−66.5±88.6% vs −17.6±140.1%, respectively, p=0.009).. Other clinical parameters such as a change in the frequency of chest pain (−3.7±0.5 vs −1.9±0.6, respectively, p=0.029), a change in the chest pain severity scale (−2.8±0.4 vs −1.1±0.4, respectively, p=0.003), and the proportion of chest pain-free patients (76.0% vs 33.3%, respectively, p=0.003) also significantly favored cilostazol.

MedicalResearch: Were any of the findings unexpected?
Dr. Kim: Cilostazol has been mainly used as an  antiplatelet agent in the area of cardiovascular drugs. Although the vasodilatory effect of cilostazol has also been studied in many of  preclinical studies,  there are few studies for providing its vasodilatorty efficacy for vasospastic angina through the clinical trials. Our study group had previously reported the potential benefit of cilostazol for reducing symptome of vasospastic angina in a pilot study (PEVA study,  Cardiovasc Ther 2013;31:179–85). To my best knowledge, it was the first report to suggest the therapeutic effect of cilostazol in vasospastic angina. The STELLA  trial is the subsequent study to confirm our pilot study result with more scientific evidence through the randomised, multicenter, double blind, placebo-controlled trial. The study result of STELLA is  consistent with our pilot report,showing that there was a 78.9% relative reduction in the score of angina intensity and a 73.5% reduction in the angina frequency after adding cilostazol to conventional medications (all p values <0.001). Any of findings was not unexpected in both of our studies (PEVA and STELLA).

MedicalResearch: What should clinicians and patients take away from your report?

Dr. Kim: Cilostazol is effective in treating vasospastic angina refractory to conventional amlodipine therapy, and does not cause any serious adverse events. Cilostazol may be considered as an add-on therapy for patients with refractory vasospastic angina.

MedicalResearch: What recommendations do you have for future research as a result of this study?

Dr. Kim: Studies of larger sample size with longer follow-up periods should be needed. Also, rather objective parameter such as acetylcholine or ergonovine provocation test before and after cilostazol than subjective parameter (chest pain symptom only) should be tested in further studies to provide more scientific evidence.


Original article: A randomised, multicentre, double blind, placebo controlled trial to evaluate the efficacy and safety of cilostazol in patients with vasospastic anginaEun-Seok Shin,Jae-Hwan Lee,Sang-Yong Yoo,Yongwhi Park,Young Joon Hong,Moo Hyun Kim,Jong-Young Lee,Chang-Wook Nam,Seung-Jea Tahk,Jeong-Su Kim,Young-Hoon Jeong,Cheol Whan Lee,Hwa Kyoung Shin,June-Hong Kim

Heart heartjnl-2014-305986Published Online First: 16 June 2014 doi:10.1136/heartjnl-2014-305986

Last Updated on November 4, 2015 by Marie Benz MD FAAD