Purpose and Background Whether pharmacologically altered high-density lipoprotein cholesterol (HDL-C) affects the risk of cardiovascular events is unfamiliar. randomization to 1 1 month for each study arm. Results One-month post-randomization mean HDL-C level was significantly higher in the cilostazol group than in the aspirin group (1.08 mmol/L vs. 1.00 mmol/L, analyses and meta-analyses of statin tests [4-8]. HDLs contribute to the process of cellular cholesterol efflux; therefore, pharmacological elevation of HDL-C levels may improve cardiovascular outcomes. However, recent clinical trials testing the efficacy of cholesteryl ester transfer protein (CETP) inhibitors that increase HDL-C levels have failed to demonstrate definite clinical benefits [9-11] due to a lack of significant association between HDL-C levels and cardiovascular risk; however, the intrinsic nature of CETP inhibitors (e.g., increasing atherogenic apoproteins) may also have affected the results . Pharmacologically altered HDL-C levels having different mechanisms may give rise to different results. HDL-C can be altered by medications other than CETP inhibitors during secondary cardiovascular prevention. For instance, cilostazol has been reported to increase HDL-C levels by activating lipoprotein lipase [13-16]. Meanwhile, probucol upregulates CETP that significantly decreases HDL-C levels , which has been considered a deleterious side effect, preventing the widespread use of probucol [17,18]. In this study, we hypothesized that medications altering HDL-C levels may influence cardiovascular risks. To test this hypothesis, we used the recent published data of the Prevention of Cardiovascular Events in SB 525334 inhibitor database Asian Patients with Ischaemic Stroke at High Risk of Cerebral Haemorrhage (PICASSO) study . In the study, cilostazol was non-inferior to aspirin for the prevention of cardiovascular events, while the addition of probucol SB 525334 inhibitor database to aspirin or cilostazol was superior to non-probucol treatment. Notably, the opposite study medications (cilostazol and probucol) in terms of HDL-C alteration were administered in the study. Here, we aimed to determine whether on-treatment changes in HDL-C levels induced by cilostazol and probucol would influence the treatment effect of each study medication. Methods Study design and population The PICASSO trial had a factorial design consisting of two main study armsantiplatelet regimens (cilostazol vs. aspirin) and lipid-lowering regimens (standard statin-based therapy plus probucol vs. standard statin-based therapy only). The rationale, design, and relevant information of the study have been previously described [19,20]. Briefly, we included patients who (1) had a history of a non-cardioembolic ischemic stroke or transient ischemic attack within 180 days ahead of enrollment; (2) had been older than twenty years; and (3) had a brief history of the earlier intracerebral hemorrhage (ICH) predicated on medical background or radiologic results (more than 8 mm in proportions on gradient echo imaging) or multiple (several) cerebral microbleeds on gradient echo imaging. We excluded individuals who (1) got a history of the hemorrhagic heart stroke within days gone by six months; (2) got circumstances contraindicating long-term antiplatelet therapy; and (3) needed dual antiplatelet therapy for a recently available acute coronary symptoms or a percutaneous coronary treatment. Individuals who have met the requirements were recruited by community researchers consecutively. All individuals or their authorized reps provided informed consent ahead of Rabbit Polyclonal to PARP (Cleaved-Asp214) research enrollment legally. Between 2009 and August 2015 August, 1,568 individuals who retrieved from heart stroke from 67 centers had been primarily screened in three countries (South Korea, China [Hong Kong], and Philippines), and 1,534 had been enrolled in the analysis (Shape 1). Patients had been randomly designated (1:1:1:1) to get dental cilostazol (100 mg double each day), aspirin (100 mg once a day time), cilostazol plus probucol (250 mg double each day), or probucol plus aspirin. Adherence to statin therapy as SB 525334 inhibitor database defined in medical practice recommendations was strongly suggested. The antiplatelet arm was a double-blind, double-dummy, placebo-controlled, randomized trial, as the probucol arm was an open-labeled, blind endpoint evaluation trial. The results assessor was blinded towards the individuals treatment assignment. Open up in another window Shape 1. Trial account. Among the intention-to-treat (ITT) human population including all randomized individuals in preventing Cardiovascular Occasions in Asian Individuals with Ischaemic Heart stroke.