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AtherosclerosisPhase 4NCT02114697

Accelerated Atherosclerosis in High Risk Population Groups: An Assessment by Magnetic Resonance Imaging

A Phase 4 study testing Statin therapy and Lifestyle modification in people with Atherosclerosis, run by Emory University at 1 site in United States.

Terminated

Stopped early. The study ended before it was planned to and will not resume.

Official record
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Trial summary

The goal of this study is to assess a slimy substance that settles/deposits along blood vessel wall. This slimy substance is called plaque. Plaque could be made up of fat, calcium or both. Plaque deposition narrows the vessels. This leads to decreased blood flow to various parts of body. Read more about this study

Who is it for?
Ages 22 years and older
Conditions the study is for
Atherosclerosis
What is being tested?
Statin therapy and Lifestyle modification
Could I receive a placebo?
No, everyone receives an active treatment
How many people
9 participants
Where
1 siteUnited States
Study dates
Apr 2014to Jul 2017
Phase
Phase 4
Are there results?
Yes, posted in the registrySummary in the doctors' view

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 22 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Age 22 and above with prior head and neck or chest irradiation
  • Six months or more post head and neck irradiation
  • Documented subclinical cardiovascular disease (inflammatory markers in the serum)
  • Pre-existing plaques (detected by ultrasound, CT or MRI)
  • Asymptomatic major arterial stenosis
  • Not being considered for arterial surgery or endovascular treatment.

Who cannot join

  • Recurrence of cancer (with or without treatment)
  • Planned surgical or endovascular intervention for revascularization of carotid arteries at the time of enrollment
  • Renal failure
  • Estimated glomerular filtration rate (eGFR) < 45 (calculation based on serum creatinine levels, race, age and gender)
  • Medically unstable or hematologic, renal, or hepatic dysfunction
  • Non-atherosclerotic arterial stenosis (dissection)
Show all 9Show fewer
  • Presence of stents or external clips that can cause artifacts impairing accurate interpretation of MRI data
  • Contraindications to MRI: cardiac pacemaker, metal implants, metal in eyes, pregnant or nursing women, claustrophobia, allergy to MRI contrast
  • Physical or mental impairment that would limit the patient's ability to comply with the medical instructions or study procedures

Trial locations and contacts

1 site in 1 country.

United States1 site
  • Emory University

    Atlanta, Georgia, 30322

Other trials in United States

About this study

The goal of this study is to assess a slimy substance that settles/deposits along blood vessel wall. This slimy substance is called plaque. Plaque could be made up of fat, calcium or both. Plaque deposition narrows the vessels. This leads to decreased blood flow to various parts of body. Blood vessels include vessels that supply to heart (coronary), vessels to brain (carotid), vessels to kidneys (renal) and vessels to legs (femoral). Decreased blood flow causes symptoms such as brain stroke, heart attack, leg pain. Similarly individuals at risk of cardiovascular disease can have certain markers elevated in their blood that can be measured by simple blood tests.

High or increased plaque deposition is seen in neck vessels of cancer patients who received radiation to chest or head and neck as part of their cancer treatment. Cancer survivors are at increased risk of plaque development and are therefore called high-risk population. Exercise +/- fat lowering medicine can potentially decrease plaque deposition and statins are one of the several fat lowering medications.

Read the detailed description

Cardiovascular disease (CVD) and cancer are the leading causes of suffering and death amongst the American population. While an ever-increasing number of cancer survivors have a favorable outcome due to advances in cancer treatment; cancer survivors remain at high risk of developing CVD at an early age. There is scant information available on the pathogenic process that contributes to cardiovascular threat amongst cancer survivors and little is known about the interventions, which may interrupt or decrease the risk of CVD in this population. Importantly, early-subclinical markers may substantially precede clinical markers.

The objective of this project is to accurately determine the constituents and characteristics of atherosclerotic plaques in carotid arteries by magnetic resonance imaging (MRI) techniques in cancer survivors; at different data intervals: before and after administration of treatment (medical and life style modification) and then correlate contrast agent dynamics with serum markers of inflammation and other tests of cardiac or vascular dysfunction, where available.

The proposed study involves 100 asymptomatic patients who received prior chest or head and neck radiation therapy (HNXRT) as part of cancer treatment. MRI data (direct assessment of atherosclerosis) would be correlated with indirect measures of atherosclerosis (blood surrogate markers \& metabolomics).

The investigators intend to conduct an initial baseline MRI, blood tests (to correlate with surrogate markers of inflammation) and other tests whenever available of cardiac or vascular dysfunction. This cohort will be followed up with medication and/or life style modification regimen for a period of initially18 months and subsequently at 36 months. A repeat of all baseline studies (MRI and blood tests) would be performed as part of the 18 and 36-month follow-up. The plaque characteristics found at MRI will be correlated with results of blood tests (baseline, 18 and 36 months) and changes in one or both will be the expected end point of the study.

Conditions
Atherosclerosis
Being tested
Statin therapy, Lifestyle modification
Keywords
Cancer survivorship, Cardiovascular disease, Stroke, Transient ischemic attack (TIA)
Medical subject headings
Atherosclerosis, Cardiovascular Diseases, Stroke, Ischemic Attack, Transient

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Statin therapyDrug

    Also called Crestor

    Statin therapy includes rosuvastatin 20 mg administered orally, once a day, for the duration of the trial, which is 3 years. Participants may also receive a different type of statin as prescribed by their cardiologist based on clinical judgement.

  • Lifestyle modificationBehavioural

    Lifestyle modification includes a recommended exercise regimen, a healthy diet and decreasing alcohol intake for 3 years.

Study groups in NCT02114697
Study groupRoleWhat they receive
Lifestyle modificationActive comparatorLifestyle modification is tailored to each participant and includes a recommended exercise regimen, a healthy diet and decreasing alcohol intake.
Receives: Behavioral: Lifestyle modification
Statin therapyExperimentalParticipants will receive statin medication along with instruction about regular exercise.
Receives: Drug: Statin therapy

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Plaque Volume of Carotid Arteries

    Plaque volume of carotid arteries were measured by MRI as a surrogate for progression of cardiovascular disease. Plaque volume varies with observed ranges from other studies ranging from 23.9 to 604.1mm^3. Plaque volume tends to increase with age. Increased plaque volume has an increased risk of vascular events.

    Measured: Baseline, 18 months, 36 months

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted15 Apr 2014 (estimated)
  2. Study startApr 2014
  3. Primary completionJul 2017
  4. Study completionJul 2017

Why it stopped: The study was stopped when the original principal investigator moved to a new institution.

Resources

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 4
Primary purpose
Treatment
Allocation
Non-randomised
Intervention model
Parallel groups
Model description
The protocol originally specified randomizing participants to a study arm, but the protocol was amended to clarify that a participant's cardiologist could change the treatment regimens that participants were assigned to so that no participant was restricted from statin therapy.
Masking
Single blind
Who is masked
Investigator
Enrolment
9 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT02114697
Sponsor's protocol ID
IRB00059784
Status last verified
Aug 2018
First submitted
10 Apr 2014
Last updated
11 Sep 2018
Data monitoring committee
Yes
FDA-regulated drug
Yes
FDA-regulated device
No

Publications

  • Ota H, Yu W, Underhill HR, Oikawa M, Dong L, Zhao X, Polissar NL, Neradilek B, Gao T, Zhang Z, Yan Z, Guo M, Zhang Z, Hatsukami TS, Yuan C. Hemorrhage and large lipid-rich necrotic cores are independently associated with thin or ruptured fibrous caps: an in vivo 3T MRI study. Arterioscler Thromb Vasc Biol. 2009 Oct;29(10):1696-701. doi: 10.1161/ATVBAHA.109.192179. Epub 2009 Jul 16.

    PubMed 19608971
  • Virmani R, Burke AP, Kolodgie FD, Farb A. Vulnerable plaque: the pathology of unstable coronary lesions. J Interv Cardiol. 2002 Dec;15(6):439-46. doi: 10.1111/j.1540-8183.2002.tb01087.x.

    PubMed 12476646
  • Yeh JM, Nekhlyudov L, Goldie SJ, Mertens AC, Diller L. A model-based estimate of cumulative excess mortality in survivors of childhood cancer. Ann Intern Med. 2010 Apr 6;152(7):409-17, W131-8. doi: 10.7326/0003-4819-152-7-201004060-00005.

    PubMed 20368646
  • Dorresteijn LD, Kappelle AC, Boogerd W, Klokman WJ, Balm AJ, Keus RB, van Leeuwen FE, Bartelink H. Increased risk of ischemic stroke after radiotherapy on the neck in patients younger than 60 years. J Clin Oncol. 2002 Jan 1;20(1):282-8. doi: 10.1200/JCO.2002.20.1.282.

    PubMed 11773180
  • Jordan LC, Duffner PK. Early-onset stroke and cerebrovascular disease in adult survivors of childhood cancer. Neurology. 2009 Dec 1;73(22):1816-7. doi: 10.1212/WNL.0b013e3181c33b10. Epub 2009 Oct 21. No abstract available.

    PubMed 19846829
  • Diller L, Chow EJ, Gurney JG, Hudson MM, Kadin-Lottick NS, Kawashima TI, Leisenring WM, Meacham LR, Mertens AC, Mulrooney DA, Oeffinger KC, Packer RJ, Robison LL, Sklar CA. Chronic disease in the Childhood Cancer Survivor Study cohort: a review of published findings. J Clin Oncol. 2009 May 10;27(14):2339-55. doi: 10.1200/JCO.2008.21.1953. Epub 2009 Apr 13. No abstract available.

    PubMed 19364955
  • Mertens AC, Yasui Y, Neglia JP, Potter JD, Nesbit ME Jr, Ruccione K, Smithson WA, Robison LL. Late mortality experience in five-year survivors of childhood and adolescent cancer: the Childhood Cancer Survivor Study. J Clin Oncol. 2001 Jul 1;19(13):3163-72. doi: 10.1200/JCO.2001.19.13.3163.

    PubMed 11432882
  • Haynes JC, Machtay M, Weber RS, Weinstein GS, Chalian AA, Rosenthal DI. Relative risk of stroke in head and neck carcinoma patients treated with external cervical irradiation. Laryngoscope. 2002 Oct;112(10):1883-7. doi: 10.1097/00005537-200210000-00034.

    PubMed 12368635
  • Bowers DC, Liu Y, Leisenring W, McNeil E, Stovall M, Gurney JG, Robison LL, Packer RJ, Oeffinger KC. Late-occurring stroke among long-term survivors of childhood leukemia and brain tumors: a report from the Childhood Cancer Survivor Study. J Clin Oncol. 2006 Nov 20;24(33):5277-82. doi: 10.1200/JCO.2006.07.2884. Epub 2006 Nov 6.

    PubMed 17088567
  • Moser EC, Noordijk EM, van Leeuwen FE, le Cessie S, Baars JW, Thomas J, Carde P, Meerwaldt JH, van Glabbeke M, Kluin-Nelemans HC. Long-term risk of cardiovascular disease after treatment for aggressive non-Hodgkin lymphoma. Blood. 2006 Apr 1;107(7):2912-9. doi: 10.1182/blood-2005-08-3392. Epub 2005 Dec 8.

    PubMed 16339404
  • Steele SR, Martin MJ, Mullenix PS, Crawford JV, Cuadrado DS, Andersen CA. Focused high-risk population screening for carotid arterial stenosis after radiation therapy for head and neck cancer. Am J Surg. 2004 May;187(5):594-8. doi: 10.1016/j.amjsurg.2004.01.014.

    PubMed 15135672
  • Casscells W, Naghavi M, Willerson JT. Vulnerable atherosclerotic plaque: a multifocal disease. Circulation. 2003 Apr 29;107(16):2072-5. doi: 10.1161/01.CIR.0000069329.70061.68. No abstract available.

    PubMed 12719287
  • Hatsukami TS, Ross R, Polissar NL, Yuan C. Visualization of fibrous cap thickness and rupture in human atherosclerotic carotid plaque in vivo with high-resolution magnetic resonance imaging. Circulation. 2000 Aug 29;102(9):959-64. doi: 10.1161/01.cir.102.9.959.

    PubMed 10961958
  • MacNeill BD, Lowe HC, Takano M, Fuster V, Jang IK. Intravascular modalities for detection of vulnerable plaque: current status. Arterioscler Thromb Vasc Biol. 2003 Aug 1;23(8):1333-42. doi: 10.1161/01.ATV.0000080948.08888.BF. Epub 2003 Jun 12.

    PubMed 12805071
  • Crisby M, Nordin-Fredriksson G, Shah PK, Yano J, Zhu J, Nilsson J. Pravastatin treatment increases collagen content and decreases lipid content, inflammation, metalloproteinases, and cell death in human carotid plaques: implications for plaque stabilization. Circulation. 2001 Feb 20;103(7):926-33. doi: 10.1161/01.cir.103.7.926.

    PubMed 11181465

Questions about this trial

What is this clinical trial studying?

A Phase 4 study testing Statin therapy and Lifestyle modification in people with Atherosclerosis, run by Emory University at 1 site in United States.

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 6 inclusion and 9 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: stopped early, as of the sponsor's last update on 11 Sep 2018. 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 States. 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. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 4 studies take place after a treatment is approved, to learn more about its long-term benefits and risks in everyday use.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

Yes. Results are posted in the registry (first posted 14 Aug 2018). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.

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?

Plaque Volume of Carotid Arteries (time frame: Baseline, 18 months, 36 months). 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 NCT02114697, which also lists 34 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 11 Sep 2018.

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