Expert Opinion on Pharmacological Treatment of Diabetic Peripheral Arterial Disease: Clinical Utility of Cilostazol/Ginkgo biloba Extract Combination (Renexin®)

Peripheral arterial disease (PAD) is a macrovascular complication of diabetes mellitus associated with a high risk of cardiovascular events, lower-extremity amputation, and impaired quality of life. Cilostazol, a phosphodiesterase-3 (PDE3) inhibitor, is recommended as a first-line pharmacological agent for symptomatic PAD based on evidence that it helps improve walking distance and potentially stabilizes plaques, partly mediated by favorable effects on triglycerides and high-density lipoprotein cholesterol. Ginkgo biloba extract improves hemorheological parameters, including plasma viscosity and hematocrit, and may increase ankle-brachial index in patients with type 2 diabetes mellitus. Also, when used in combination therapy, cilostazol attenuates carotid intima-media thickness progression. However, high-quality evidence for G. biloba extract in diabetic PAD remains limited. Based on a comprehensive review of available clinical evidence and expert consensus, this expert opinion recommends G. biloba extract combination with cilostazol (Renexin®) as a second-line agent or adjunctive therapy primarily for symptom control—particularly the improvement of maximal walking distance—in patients with diabetic PAD who experience insufficient symptom control or intolerance to cilostazol monotherapy. This expert opinion also emphasizes individualized patient selection, careful screening for contraindications, and regular clinical monitoring, and urges large-scale randomized controlled trials in Korean patients with PAD to further establish a greater evidence base for pharmacological treatment.

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Journal
Journal of Korean Diabetes
Published
2026-06-30
DOI
https://doi.org/10.4093/jkd.2026.27.2.56
Primary Topic
Peripheral Artery Disease Management
Type
article
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article

Expert Opinion on Pharmacological Treatment of Diabetic Peripheral Arterial Disease: Clinical Utility of Cilostazol/Ginkgo biloba Extract Combination (Renexin®)

Tae Jung Oh, Hyunmin Ko, Yeoree Yang, Jeehee Yoon et al.
Journal of Korean Diabetes
Peripheral Artery Disease Management
article

Expert Opinion on Pharmacological Treatment of Diabetic Peripheral Arterial Disease: Clinical Utility of Cilostazol/Ginkgo biloba Extract Combination (Renexin®)

Tae Jung Oh, Hyunmin Ko, Yeoree Yang, Jeehee Yoon, Jung-hwa Lee, Seon Mee Kang, Jun Hwa Hong, HoChan Cho, H Kim, S H Park, Dal Lae Ju, Ah Reum Khang, Chong Hwa Kim, Sun Young Kim, Ji‐Hyun Lee, Soo Kyoung Kim, Jin Woo Jeong, Dughyun Choi, Won Jun Kim, Chang Hoon Lee, Ju Hee Lee
article en

Abstract

Peripheral arterial disease (PAD) is a macrovascular complication of diabetes mellitus associated with a high risk of cardiovascular events, lower-extremity amputation, and impaired quality of life. Cilostazol, a phosphodiesterase-3 (PDE3) inhibitor, is recommended as a first-line pharmacological agent for symptomatic PAD based on evidence that it helps improve walking distance and potentially stabilizes plaques, partly mediated by favorable effects on triglycerides and high-density lipoprotein cholesterol. Ginkgo biloba extract improves hemorheological parameters, including plasma viscosity and hematocrit, and may increase ankle-brachial index in patients with type 2 diabetes mellitus. Also, when used in combination therapy, cilostazol attenuates carotid intima-media thickness progression. However, high-quality evidence for G. biloba extract in diabetic PAD remains limited. Based on a comprehensive review of available clinical evidence and expert consensus, this expert opinion recommends G. biloba extract combination with cilostazol (Renexin®) as a second-line agent or adjunctive therapy primarily for symptom control—particularly the improvement of maximal walking distance—in patients with diabetic PAD who experience insufficient symptom control or intolerance to cilostazol monotherapy. This expert opinion also emphasizes individualized patient selection, careful screening for contraindications, and regular clinical monitoring, and urges large-scale randomized controlled trials in Korean patients with PAD to further establish a greater evidence base for pharmacological treatment.

Journal of Korean DiabetesVol. 27(2)
Eulji University (KR), Soonchunhyang University (KR), Soonchunhyang University Hospital Seoul (KR), Samsung Medical Center (KR), Seoul National University Hospital (KR), Seoul National University Bundang Hospital (KR), Gyeongsang National University Hospital (KR), Veterans Health Service Medical Center (KR), Ajou University Hospital (KR), Sejong General Hospital (KR), Gangneung Asan Hospital (KR), Chungnam National University Hospital (KR), Chonnam National University Hwasun Hospital (KR), Pusan National University Yangsan Hospital (KR), Kyung Hee University Hospital at Gangdong (KR), Chung-Ang University Hospital (KR), The Catholic University of Korea Seoul St. Mary's Hospital (KR), Keimyung University (KR), Bucheon University (KR), Wonkwang University (KR), Catholic University of Korea (KR)
Good health and well-being
Openalex Percentile: Top 7%
Peripheral Artery Disease Management
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