Cardiovascular DiseaseFLAVONCT00568152
Effect of Apple Flavanols on Risk of Cardiovascular Disease
A study testing Low PA apple puree, High PA apple puree and Aspirin in people with Cardiovascular Disease, run by Quadram Institute Bioscience at 1 site in United Kingdom.
Trial summary
A randomised three period cross over trial will be carried out in adults (19-64 years) to assess the acute and chronic effects of a large dose of apple procyanidin (PA) compared with a low dose of apple PA (negative control) and aspirin (positive control), on platelet function and other risk factors of cardiovascular… Read more about this study
- Who is it for?
- Ages 19 to 64 yearsHealthy volunteers can take part
- Conditions the study is for
- Cardiovascular Disease
- What is being tested?
- Low PA apple puree, High PA apple puree and Aspirin
- Could I receive a placebo?
- Yes, some participants may receive a placebo
- How many people
- 26 participants
- Where
- 1 siteUnited Kingdom
- Study dates
- May 2006to May 2008
- Phase
- Interventional
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 19 to 64 years
- All sexes
- Healthy volunteers accepted
- Adult
Who may be able to join
- male and female aged 19-64
Who cannot join
- Smokers, very low or high pressure (<90/50 or <95/55 if symptomatic or >160/100), BMI <18.5 or >35, pregnant or have been pregnant in last 12 months, diagnosed with gastrointestinal disease, history of ulcers and gastrointestinal bleeding, diagnosed with a long term illness requiring active treatment, history of stroke, on regularly prescribed medication known to have a profound effect on cardiovascular disease risk factors, using non steroidal anti inflammatory cream, sufferers of asthma or hay fever, known intolerance to aspirin, allergic to apples or birch pollen, regular use of aspirin, antacids or laxatives, unwillingness to discontinue specific dietary or herbal supplements less than 1 month prior to the start of the study, blood donation within 16 weeks of the first study sample, antibiotic use within 4 weeks prior to starting the study, those who receive or plan to receive any type of immunisation within 4 weeks of the start of the study, parallel participation in any other research project.
Trial locations and contacts
1 site in 1 country.
United Kingdom1 site
Institue of Food Research
Norwich, Norfolk, NR4 7UA
About this study
A randomised three period cross over trial will be carried out in adults (19-64 years) to assess the acute and chronic effects of a large dose of apple procyanidin (PA) compared with a low dose of apple PA (negative control) and aspirin (positive control), on platelet function and other risk factors of cardiovascular disease. Platelet function will be assessed prior to a run in diet and at the start and end of each intervention. Volunteers will be assigned at random to consume 230grams of low PA apple puree or high PA apple puree or aspirin (75mg) each day for 2 weeks followed by a minimum 14 day wash out.
Hypothesis: Consuming apple PA reduces platelet function consistent with reduced risk of cardiovascular disease.
Read the detailed description
A randomised 3-period cross-over trial will be carried out to assess the acute and chronic effects of a large dose of apple PA compared with a low dose of apple PA (negative control) and aspirin (positive control), on platelet function (flow cytometry) and other risk factors of CVD (endothelial function, plasma antioxidants, inflammatory markers, lipid profile). Once recruited, volunteers will be assigned at random to consume 230g of low PA apple puree or high PA apple puree or aspirin (75mg) each day for 14 days in period 1. Following a minimum 14 day wash-out volunteers will then be crossed over for period 2 and after another 14-day wash-out volunteers will be crossed over to complete period 3 of the intervention (flow chart I). The acute effect of each treatment will be investigated on day 15 of each period. A fasting blood sample will be obtained prior to consumption of a standard breakfast and the apple puree or aspirin. Further blood samples will then be obtained at 2, 6 and 24 hours post-dosing. The chronic effect of all three treatments will be determined by measuring CVD risk factors in fasting blood samples obtained on day 1, 15 and 29. Flow chart II provides a more detailed overview of the design of each period which is identical for the apple puree treatments and differs only in the omission of urine collections and PWV measurements for the aspirin period. During the apple puree interventions phenolic acids will be analysed in 24-hour urine pools collected on the day prior to the start of each period, as well as on day 14, 15, and 28. PWV measurements will be carried on day 15 and 29 after a 12-hour overnight fast for each of the 2 apple intervention periods.
For the intervention to be successful it is necessary to exclude some food sources that contribute significantly to total PA intake (e.g. cocoa, berries, grapes, red wine, apples, legumes) and limit other PA food sources (tea/coffee) to levels that support compliance and are unlikely to mask any effects of the intervention. Because of its well documented effect on platelet function alcohol will be restricted to a maximum of 2 units per day and excluded completely for the 48 hours prior to blood sampling appointments. Oily fish consumption will be limited to 2 portions per week and will not be allowed for 48 hours prior to blood sampling. These dietary restrictions may have significant effects on platelet function in individuals that consume these foods regularly. Therefore, dietary restrictions will apply during a 14-day run-in diet prior to and for the duration of each intervention period. Platelet function will be assessed prior to the start of the run-in diet as well as at the start and end of each PA/aspirin intervention (flow chart II).
Male and female volunteers aged 19 to 64 will be recruited and screened for eligibility for up to 2 months prior to the start of the intervention. Those meeting the study criteria will be randomly assigned to one out of the six possible treatment orders, i.e. ABC, ACB, BAC, CAB, BCA, CBA. Randomisation will be stratified by sex.
Volunteers will be given a user friendly booklet (Run-in diet/Apple/Aspirin diary) for each intervention period to record apple puree/aspirin consumption and volunteers will also be prompted to record their alcohol, tea/coffee and oily fish intake (Annex 2). Foods not allowed during each intervention period are listed. Volunteers will be reminded not to consume oily fish (as listed), alcohol, coffee and tea 48 hours prior to a blood sampling appointment.
- Conditions
- Cardiovascular Disease
- Being tested
- Low PA apple puree, High PA apple puree, Aspirin
- Keywords
- Apples, Dietary intervention, Procyanidins
- Medical subject headings
- Cardiovascular Diseases
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Low PA apple pureeDietary supplement
Golden Delicious apple puree 230grams consumed daily for 14 days
High PA apple pureeDietary supplement
High PA apple puree (Mitchalin) consumed daily for 14 days
AspirinDrug
75mg dispersable aspirin taken daily for 14 days
| Study group | Role | What they receive |
|---|---|---|
| Low PA apple puree | Experimental | 230grams of low PA apple puree (Golden Delicious) consumed daily for 14 days. Receives: Dietary Supplement: Low PA apple puree |
| High PA apple puree | Experimental | High PA apple puree (Mitchalin) 230grams consumed daily for 14 days Receives: Dietary Supplement: High PA apple puree |
| Aspirin | Placebo comparator | 75mg dispersable aspirin taken daily for 14 days Receives: Drug: Aspirin |
What is being measured
The primary outcome is the main question the study is designed to answer.
The aim of this trial is to investigate the effect of consuming apple PA on platelet function.
Measured: 16 weeks
Secondary outcomes (1)
To measure the bioavailability of PA and metabolites from two well characterised apple purees providing a low and high dose of PA.
Measured: 16 weeks
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted5 Dec 2007 (estimated)
- Study startMay 2006
- Study completionMay 2008
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (10)Papers the sponsor has linked to this study.
- Other trials for Cardiovascular DiseaseStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Prevention
- Allocation
- Randomised
- Intervention model
- Crossover
- Masking
- Single blind
- Who is masked
- Participant
- Enrolment
- 26 participants (actual)
Sponsor and investigators
- Lead sponsor
- Quadram Institute Bioscience
- Sponsor type
- University, hospital or other
- Responsible party
- Sponsor
- Investigators
- Paul Kroon, Principal investigator, Quadram Institute BioscienceAmy Gasper, Principal investigator, Quadram Institute Bioscience
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT00568152
- Sponsor's protocol ID
- IFR02-2006
- Other IDs
- 06/Q101/22
- Acronym
- FLAVO
- Status last verified
- Mar 2013
- First submitted
- 4 Dec 2007
- Last updated
- 6 Mar 2013
- Results posted
- No
- Data monitoring committee
- Yes
Publications
Ambrose JA, Barua RS. The pathophysiology of cigarette smoking and cardiovascular disease: an update. J Am Coll Cardiol. 2004 May 19;43(10):1731-7. doi: 10.1016/j.jacc.2003.12.047.
PubMed 15145091Donovan JL, Manach C, Rios L, Morand C, Scalbert A, Remesy C. Procyanidins are not bioavailable in rats fed a single meal containing a grapeseed extract or the procyanidin dimer B3. Br J Nutr. 2002 Apr;87(4):299-306. doi: 10.1079/bjnbjn2001517.
PubMed 12064339DuPont MS, Day AJ, Bennett RN, Mellon FA, Kroon PA. Absorption of kaempferol from endive, a source of kaempferol-3-glucuronide, in humans. Eur J Clin Nutr. 2004 Jun;58(6):947-54. doi: 10.1038/sj.ejcn.1601916.
PubMed 15164116Gimenez R, Cabrera C, Olalla M, Ruiz MD, Lopez MC. Ascorbic acid in diet supplements: loss in the manufacturing process and storage. Int J Food Sci Nutr. 2002 Nov;53(6):509-18. doi: 10.1080/09637480220164352.
PubMed 12590746Heiss C, Kleinbongard P, Dejam A, Perre S, Schroeter H, Sies H, Kelm M. Acute consumption of flavanol-rich cocoa and the reversal of endothelial dysfunction in smokers. J Am Coll Cardiol. 2005 Oct 4;46(7):1276-83. doi: 10.1016/j.jacc.2005.06.055.
PubMed 16198843Holt RR, Lazarus SA, Sullards MC, Zhu QY, Schramm DD, Hammerstone JF, Fraga CG, Schmitz HH, Keen CL. Procyanidin dimer B2 [epicatechin-(4beta-8)-epicatechin] in human plasma after the consumption of a flavanol-rich cocoa. Am J Clin Nutr. 2002 Oct;76(4):798-804. doi: 10.1093/ajcn/76.4.798.
PubMed 12324293McKenzie ME, Malinin AI, Bell CR, Dzhanashvili A, Horowitz ED, Oshrine BR, Atar D, Serebruany VL. Aspirin inhibits surface glycoprotein IIb/IIIa, P-selectin, CD63, and CD107a receptor expression on human platelets. Blood Coagul Fibrinolysis. 2003 Apr;14(3):249-53. doi: 10.1097/01.mbc.0000046182.72384.ab.
PubMed 12695747Tsang C, Auger C, Mullen W, Bornet A, Rouanet JM, Crozier A, Teissedre PL. The absorption, metabolism and excretion of flavan-3-ols and procyanidins following the ingestion of a grape seed extract by rats. Br J Nutr. 2005 Aug;94(2):170-81. doi: 10.1079/bjn20051480.
PubMed 16115350Tsiara S, Elisaf M, Jagroop IA, Mikhailidis DP. Platelets as predictors of vascular risk: is there a practical index of platelet activity? Clin Appl Thromb Hemost. 2003 Jul;9(3):177-90. doi: 10.1177/107602960300900301.
PubMed 14507105Williamson G, Manach C. Bioavailability and bioefficacy of polyphenols in humans. II. Review of 93 intervention studies. Am J Clin Nutr. 2005 Jan;81(1 Suppl):243S-255S. doi: 10.1093/ajcn/81.1.243S.
PubMed 15640487
Study at a glance
From the registry record, last updated by the sponsor on 6 Mar 2013. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Effect of Apple Flavanols on Risk of Cardiovascular Disease
- ClinicalTrials.gov ID
- NCT00568152
- Acronym / sponsor ID
- FLAVO / IFR02-2006
- Conditions
- Cardiovascular Disease
- Keywords
- Apples, Dietary intervention, Procyanidins
- Study type
- Interventional
- Recruitment status
- Completed
- Enrolment
- 26 participants (actual)
- Lead sponsor
- Quadram Institute BioscienceUniversity, hospital or other
- Study start
- May 2006
- Study completion
- May 2008 (actual)
- First posted
- 5 Dec 2007 (estimated)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
A randomised three period cross over trial will be carried out in adults (19-64 years) to assess the acute and chronic effects of a large dose of apple procyanidin (PA) compared with a low dose of apple PA (negative control) and aspirin (positive control), on platelet function and other risk factors of cardiovascular disease. Platelet function will be assessed prior to a run in diet and at the start and end of each intervention. Volunteers will be assigned at random to consume 230grams of low PA apple puree or high PA apple puree or aspirin (75mg) each day for 2 weeks followed by a minimum 14 day wash out.
Hypothesis: Consuming apple PA reduces platelet function consistent with reduced risk of cardiovascular disease.
Detailed description
A randomised 3-period cross-over trial will be carried out to assess the acute and chronic effects of a large dose of apple PA compared with a low dose of apple PA (negative control) and aspirin (positive control), on platelet function (flow cytometry) and other risk factors of CVD (endothelial function, plasma antioxidants, inflammatory markers, lipid profile). Once recruited, volunteers will be assigned at random to consume 230g of low PA apple puree or high PA apple puree or aspirin (75mg) each day for 14 days in period 1. Following a minimum 14 day wash-out volunteers will then be crossed over for period 2 and after another 14-day wash-out volunteers will be crossed over to complete period 3 of the intervention (flow chart I). The acute effect of each treatment will be investigated on day 15 of each period. A fasting blood sample will be obtained prior to consumption of a standard breakfast and the apple puree or aspirin. Further blood samples will then be obtained at 2, 6 and 24 hours post-dosing. The chronic effect of all three treatments will be determined by measuring CVD risk factors in fasting blood samples obtained on day 1, 15 and 29. Flow chart II provides a more detailed overview of the design of each period which is identical for the apple puree treatments and differs only in the omission of urine collections and PWV measurements for the aspirin period. During the apple puree interventions phenolic acids will be analysed in 24-hour urine pools collected on the day prior to the start of each period, as well as on day 14, 15, and 28. PWV measurements will be carried on day 15 and 29 after a 12-hour overnight fast for each of the 2 apple intervention periods.
For the intervention to be successful it is necessary to exclude some food sources that contribute significantly to total PA intake (e.g. cocoa, berries, grapes, red wine, apples, legumes) and limit other PA food sources (tea/coffee) to levels that support compliance and are unlikely to mask any effects of the intervention. Because of its well documented effect on platelet function alcohol will be restricted to a maximum of 2 units per day and excluded completely for the 48 hours prior to blood sampling appointments. Oily fish consumption will be limited to 2 portions per week and will not be allowed for 48 hours prior to blood sampling. These dietary restrictions may have significant effects on platelet function in individuals that consume these foods regularly. Therefore, dietary restrictions will apply during a 14-day run-in diet prior to and for the duration of each intervention period. Platelet function will be assessed prior to the start of the run-in diet as well as at the start and end of each PA/aspirin intervention (flow chart II).
Male and female volunteers aged 19 to 64 will be recruited and screened for eligibility for up to 2 months prior to the start of the intervention. Those meeting the study criteria will be randomly assigned to one out of the six possible treatment orders, i.e. ABC, ACB, BAC, CAB, BCA, CBA. Randomisation will be stratified by sex.
Volunteers will be given a user friendly booklet (Run-in diet/Apple/Aspirin diary) for each intervention period to record apple puree/aspirin consumption and volunteers will also be prompted to record their alcohol, tea/coffee and oily fish intake (Annex 2). Foods not allowed during each intervention period are listed. Volunteers will be reminded not to consume oily fish (as listed), alcohol, coffee and tea 48 hours prior to a blood sampling appointment.
Study design
- Primary purpose
- Prevention
- Allocation
- Randomised
- Intervention model
- Crossover
- Masking
- Single blind (participant)
- Number of arms
- 3
| Arm | Type | Receives |
|---|---|---|
| Low PA apple puree | Experimental | Dietary Supplement: Low PA apple puree230grams of low PA apple puree (Golden Delicious) consumed daily for 14 days. |
| High PA apple puree | Experimental | Dietary Supplement: High PA apple pureeHigh PA apple puree (Mitchalin) 230grams consumed daily for 14 days |
| Aspirin | Placebo comparator | Drug: Aspirin75mg dispersable aspirin taken daily for 14 days |
Who may qualify
- Ages
- 19 to 64 years
- Sex
- All
- Healthy volunteers
- Accepted
- Age groups
- Adult
Key inclusion criteria (1 listed)
- male and female aged 19-64
Key exclusion criteria (1 listed)
- Smokers, very low or high pressure (<90/50 or <95/55 if symptomatic or >160/100), BMI <18.5 or >35, pregnant or have been pregnant in last 12 months, diagnosed with gastrointestinal disease, history of ulcers and gastrointestinal bleeding, diagnosed with a long term illness requiring active treatment, history of stroke, on regularly prescribed medication known to have a profound effect on cardiovascular disease risk factors, using non steroidal anti inflammatory cream, sufferers of asthma or hay fever, known intolerance to aspirin, allergic to apples or birch pollen, regular use of aspirin, antacids or laxatives, unwillingness to discontinue specific dietary or herbal supplements less than 1 month prior to the start of the study, blood donation within 16 weeks of the first study sample, antibiotic use within 4 weeks prior to starting the study, those who receive or plan to receive any type of immunisation within 4 weeks of the start of the study, parallel participation in any other research project.
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Low PA apple pureeGolden Delicious apple puree 230grams consumed daily for 14 days | Dietary supplement | Low PA apple puree |
| High PA apple pureeHigh PA apple puree (Mitchalin) consumed daily for 14 days | Dietary supplement | High PA apple puree |
| Aspirin75mg dispersable aspirin taken daily for 14 days | Drug | Aspirin |
Primary outcome
The aim of this trial is to investigate the effect of consuming apple PA on platelet function.
Time frame: 16 weeks
1 secondary outcome
To measure the bioavailability of PA and metabolites from two well characterised apple purees providing a low and high dose of PA.
Time frame: 16 weeks
Results and safety
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 6 Mar 2013.
- Background: PubMed 15145091Ambrose JA, Barua RS. The pathophysiology of cigarette smoking and cardiovascular disease: an update. J Am Coll Cardiol. 2004 May 19;43(10):1731-7. doi: 10.1016/j.jacc.2003.12.047.
- Background: PubMed 12064339Donovan JL, Manach C, Rios L, Morand C, Scalbert A, Remesy C. Procyanidins are not bioavailable in rats fed a single meal containing a grapeseed extract or the procyanidin dimer B3. Br J Nutr. 2002 Apr;87(4):299-306. doi: 10.1079/bjnbjn2001517.
- Background: PubMed 15164116DuPont MS, Day AJ, Bennett RN, Mellon FA, Kroon PA. Absorption of kaempferol from endive, a source of kaempferol-3-glucuronide, in humans. Eur J Clin Nutr. 2004 Jun;58(6):947-54. doi: 10.1038/sj.ejcn.1601916.
- Background: PubMed 12590746Gimenez R, Cabrera C, Olalla M, Ruiz MD, Lopez MC. Ascorbic acid in diet supplements: loss in the manufacturing process and storage. Int J Food Sci Nutr. 2002 Nov;53(6):509-18. doi: 10.1080/09637480220164352.
- Background: PubMed 16198843Heiss C, Kleinbongard P, Dejam A, Perre S, Schroeter H, Sies H, Kelm M. Acute consumption of flavanol-rich cocoa and the reversal of endothelial dysfunction in smokers. J Am Coll Cardiol. 2005 Oct 4;46(7):1276-83. doi: 10.1016/j.jacc.2005.06.055.
- Background: PubMed 12324293Holt RR, Lazarus SA, Sullards MC, Zhu QY, Schramm DD, Hammerstone JF, Fraga CG, Schmitz HH, Keen CL. Procyanidin dimer B2 [epicatechin-(4beta-8)-epicatechin] in human plasma after the consumption of a flavanol-rich cocoa. Am J Clin Nutr. 2002 Oct;76(4):798-804. doi: 10.1093/ajcn/76.4.798.
- Background: PubMed 12695747McKenzie ME, Malinin AI, Bell CR, Dzhanashvili A, Horowitz ED, Oshrine BR, Atar D, Serebruany VL. Aspirin inhibits surface glycoprotein IIb/IIIa, P-selectin, CD63, and CD107a receptor expression on human platelets. Blood Coagul Fibrinolysis. 2003 Apr;14(3):249-53. doi: 10.1097/01.mbc.0000046182.72384.ab.
- Background: PubMed 16115350Tsang C, Auger C, Mullen W, Bornet A, Rouanet JM, Crozier A, Teissedre PL. The absorption, metabolism and excretion of flavan-3-ols and procyanidins following the ingestion of a grape seed extract by rats. Br J Nutr. 2005 Aug;94(2):170-81. doi: 10.1079/bjn20051480.
- Background: PubMed 14507105Tsiara S, Elisaf M, Jagroop IA, Mikhailidis DP. Platelets as predictors of vascular risk: is there a practical index of platelet activity? Clin Appl Thromb Hemost. 2003 Jul;9(3):177-90. doi: 10.1177/107602960300900301.
- Background: PubMed 15640487Williamson G, Manach C. Bioavailability and bioefficacy of polyphenols in humans. II. Review of 93 intervention studies. Am J Clin Nutr. 2005 Jan;81(1 Suppl):243S-255S. doi: 10.1093/ajcn/81.1.243S.
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Paul Kroon principal investigator
Quadram Institute Bioscience
Amy Gasper principal investigator
Quadram Institute Bioscience
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Low PA apple puree, High PA apple puree and Aspirin in people with Cardiovascular Disease, run by Quadram Institute Bioscience at 1 site in United Kingdom.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 1 inclusion and 1 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 6 Mar 2013. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in United Kingdom. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. Some participants in this study may receive a placebo. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
The aim of this trial is to investigate the effect of consuming apple PA on platelet function. (time frame: 16 weeks). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT00568152, which also lists 10 linked publications.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 6 Mar 2013.