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Carotid StenosisNCT03929354

Lifestyle Modification Programme for Patients With Asymptomatic Carotid Artery Stenosis

A study testing Risk Factors Modification Programme in people with Carotid Stenosis, run by Western Vascular Institute, Ireland at 1 site in Ireland.

Unknown status

Status not confirmed. The sponsor has not verified this record for over two years, so it may be out of date.

Official record
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Trial summary

This study randomises patients with patients with asymptomatic carotid artery stenosis, to be managed either by providing an intensive 12-week lifestyle modification programme, or standard healthcare. Read more about this study

Who is it for?
Ages 18 to 100 years
Conditions the study is for
Carotid Stenosis
What is being tested?
Risk Factors Modification Programme
Could I receive a placebo?
No, everyone receives an active treatment
How many people
208 participants
Where
1 siteIreland
Study dates
1 Jun 2018to 1 Sep 2022
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 18 to 100 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Adults aged 18 years or more.
  • Provide written informed consent.
  • History of asymptomatic carotid artery stenosis, defined as a stenosis of the internal carotid artery of 50% or higher, but without history of any cerebrovascular events within the previous 6 months.
  • Patients should have at least one of the following risk factors:
  • Blood pressure > 140/80 mmHg
  • Fasting blood sugar > 53 mmol/mol (HbA1c > 7%)
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  • Total cholesterol > 5 mmol/l
  • Low-density lipoprotein (LDL) cholesterol > 2.6 mmol/l
  • Triglycerides > 1.7 mmol/l
  • High-density lipoprotein (HDL) cholesterol ˂ 1.2 mmol/l in females, and ˂ 1 mmol/l in males.
  • Body mass index (BMI) > 25 kg/m^2.
  • Waist circumference of > 80 cm in women, and > 94 cm in men.
  • Mediterranean diet score < 12
  • Physically inactive.
  • Current smoker or exposure to tobacco in any form.

Who cannot join

  • Patients with symptomatic carotid stenosis and with a documented symptomatic cerebrovascular event. A cerebrovascular event is considered if the patient experienced any of an amaurosis fugax, transient ischaemic attack (TIA), or stroke within the past 6 months.
  • Significant cognitive impairment or mental illness.
  • Currently pregnant women (confirmed by β-Human chorionic gonadotropin (HCG) analysis).
  • Inadequate English language ability to understand the content of the intervention programme.
  • Involvement in another clinical trial in the previous six months.
  • Legal incapacity.
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  • Patient is bed-ridden or immobile.
  • Contraindication to antiplatelet or anticoagulation therapy, or any of risk factor medications.
  • Presence of any illness that could limit long-term compliance.

Trial locations and contacts

1 site in 1 country.

Wael Tawfick, MB BcH,MRCSI contact

+ 35391542535

wael.tawfick@hse.ie

Sherif Sultan, MD, FRCSI contact

+35391542534

sherif.sultan@hse.ie

Ireland1 site, 1 recruiting
  • Department of Vascular Surgery, Western Vascular Institute, Galway University Hospital

    Galway

    Sherif Sultan, MD, +35391542534, sherif.sultan@hse.ie

    Wael Tawfick, MD, +35391542535, wael.tawfick@hse.ie

    Recruiting

Other trials in Ireland

About this study

Official title: Intensive Lifestyle Modification Programme Versus Standard Care for Risk Factor Reduction and Stroke Prevention in Patients With Asymptomatic Carotid Artery Stenosis. A Prospective Randomised Controlled Trial

This study randomises patients with patients with asymptomatic carotid artery stenosis, to be managed either by providing an intensive 12-week lifestyle modification programme, or standard healthcare.

Read the detailed description

Cardiovascular disease (CVD) is the leading cause of mortality and acquired disability globally. According to the World Health Organisation (WHO), 30% of total global deaths are due to CVD, and approximately 6 million deaths result from cerebrovascular disease.

A common cause of cerebrovascular disease is internal carotid artery stenosis. Despite recent advances in carotid artery revascularisation, risk factor modification remains the cornerstone of therapy for this devastating disease. According to the European Society of Cardiology (ESC), the lifestyle risk factors for vascular diseases include; cigarette smoking, physical inactivity, increased body mass index, and unhealthy diet, and stress, while the medical risk factors include; High blood pressure, elevated blood sugar, and hyperlipidaemia. All these factors have been identified in several studies as significant modifiable risk factors that should be targeted for preventing morbidity and mortality resulting from cerebrovascular disease.

Previous studies indicated that modifiable risk factor programmes can help cardiac patients to achieve their risk factor modification targets. However, to date there do not seem to be any studies assessing the outcomes of a multidisciplinary risk factor modification programme in patients with carotid artery stenosis. Our study will evaluate the impact of an intensive 12-week, multidisciplinary risk factors modification programme on medical and lifestyle risk factors modification, as well as on risk reduction for stroke and cardiovascular events, among patients with asymptomatic carotid artery stenosis. We will compare these outcomes to that of standard care traditionally provided to this high-risk patient group.

Being tested
Risk Factors Modification Programme, Standard Care
Keywords
Asymptomatic Carotid Artery Stenosis, Cardiovascular risk factors, Risk factor modification
Medical subject headings
Carotid Stenosis

What participants receive

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

  • Risk Factors Modification ProgrammeBehavioural

    12-week supervised risk factor modification programme derived from the EuroAction Study standards.

  • Standard CareBehavioural

    Patients advised to adjust lifestyle without the support of the structured supervised programme.

Study groups in NCT03929354
Study groupRoleWhat they receive
Risk Factors Modification ProgrammeExperimental* Patients in the intervention arm will attend the 12-week intensive lifestyle programme which includes healthy lifestyle change such as smoking cessation, healthy food choices and increasing physical activity levels, as well as management of cholesterol, diabetes, and blood pressure. * The 12-week programme will consist of 12 sessions of 2.5 hours each per week. * Each of the weekly sessions will incorporate an individualised meeting between the multidisciplinary healthcare team and each patient to review the progress and health goals. * The weekly sessions will also include a one-hour group exercise programme and an educational workshop.
Receives: Behavioral: Risk Factors Modification Programme
Standard CareActive comparatorStandard care is defined as giving information and advice to the patients to modify their lifestyles but without providing a structured intervention or an individualised plan.
Receives: Behavioral: Standard Care

What is being measured

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

  1. Achieve Lifestyle modification target

    This is a composite primary endpoint. The patient will be considered to have achieved the composite primary endpoint if they achieve any one or more of the following targets:

    1. Smoking cessation.
    2. Body Mass Index (BMI) between 20 to 25 kg/m^2. BMI is calculated by dividing body weight in kilograms by the square of height in metres.
    3. Glycosylated Haemoglobin (HbA1C) less than 7%.

    Measured: 12 weeks

Secondary outcomes (6)
  1. Cardiovascular events

    Any of cerebrovascular events (Transient ischaemic attack or stroke), myocardial infarction, or death.

    Measured: 1 year

  2. Changes in the degree of carotid artery stenosis

    Any increase or decrease in the percentage of internal carotid artery stenosis, documented by duplex scan.

    Measured: 1 year

  3. Carotid artery revascularisation

    Any need for carotid endarterectomy or carotid stenting, with any documented procedure complications.

    Measured: 1 year

  4. Re-intervention rates

    Any re-intervention among patients who already underwent carotid revascularisation procedures.

    Measured: 1 year

  5. Change in cognitive function

    Assessed using the Mini-Mental State Examination (MMSE) at enrolment and after one year.

    The Mini-Mental State Examination (MMSE) is a validated 30-point questionnaire that is used extensively in clinical and research settings to measure cognitive impairment, patient's orientation, attention, memory, language, and visual-spatial skills.

    The maximum score is 30 points (out of 30). Any score greater than or equal to 24 points (out of 30) indicates a normal cognition. Below this, scores can indicate severe (≤9 points), moderate (10-18 points) or mild (19-23 points) cognitive impairment. Moderate to low scores correlate closely with the presence of dementia. A version of the MMSE questionnaire can be found on the British Columbia Ministry of Health website.

    Measured: 1 year

  6. Change in quality of life

    Assessed using the Dartmouth Cooperative Information Project (COOP) charts at enrolment and after one year.

    The COOP charts measure six core aspects of functional status: physical fitness, feelings, daily activities, social activities, change in health, pain, and overall health. The instrument consists of six charts, referring to the above mentioned aspects of functioning. Each chart consists of a simple title, a question referring to the status of the patient and an ordinal five-point response scale illustrated with a simple drawing.

    Each item is rated on this five-point ordinal scale ranging from 1 (no limitation at all) to 5 (severely limited); for 'change in health' score 1 means 'much better' and score 5 'much worse'. The designers do not advocate summing the responses to gain a single index figure of health status.

    Measured: 1 year

Timeline

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

  1. First posted26 Apr 2019
  2. Study start1 Jun 2018
  3. Primary completion1 Sep 2022 (estimated)
  4. Study completion1 Sep 2022 (estimated)

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 N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Model description
This is a randomised, parallel group, active-control trial, with patients randomised in a 1:1 ratio to one of two treatment arms.
Masking
Double blind
Who is masked
Investigator, Outcomes assessor
Enrolment
208 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT03929354
Sponsor's protocol ID
WVI-CAS
Status last verified
Jul 2021
First submitted
19 Dec 2018
Last updated
4 Aug 2021
Results posted
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No: Individual participant data (IPD) of primary and secondary outcomes, could be made available to other researchers by request, while maintaining participant confidentiality

Publications

  • Perk J, De Backer G, Gohlke H, Graham I, Reiner Z, Verschuren WM, Albus C, Benlian P, Boysen G, Cifkova R, Deaton C, Ebrahim S, Fisher M, Germano G, Hobbs R, Hoes A, Karadeniz S, Mezzani A, Prescott E, Ryden L, Scherer M, Syvanne M, Scholte Op Reimer WJ, Vrints C, Wood D, Zamorano JL, Zannad F; Comitato per Linee Guida Pratiche (CPG) dell'ESC. [European Guidelines on Cardiovascular Disease Prevention in Clinical Practice (version 2012). The Fifth Joint Task Force of the European Society of Cardiology and other societies on cardiovascular disease prevention in clinical practice (constituted by representatives of nine societies and by invited experts)]. G Ital Cardiol (Rome). 2013 May;14(5):328-92. doi: 10.1714/1264.13964. No abstract available. Italian.

    PubMed 23612326
  • Piepoli MF, Hoes AW, Agewall S, Albus C, Brotons C, Catapano AL, Cooney MT, Corra U, Cosyns B, Deaton C, Graham I, Hall MS, Hobbs FDR, Lochen ML, Lollgen H, Marques-Vidal P, Perk J, Prescott E, Redon J, Richter DJ, Sattar N, Smulders Y, Tiberi M, van der Worp HB, van Dis I, Verschuren WMM. [2016 European guidelines on cardiovascular disease prevention in clinical practice. The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts. Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation]. G Ital Cardiol (Rome). 2017 Jul-Aug;18(7):547-612. doi: 10.1714/2729.27821. No abstract available. Italian.

    PubMed 28714997
  • Kaikkonen JE, Mikkila V, Magnussen CG, Juonala M, Viikari JS, Raitakari OT. Does childhood nutrition influence adult cardiovascular disease risk?--insights from the Young Finns Study. Ann Med. 2013 Mar;45(2):120-8. doi: 10.3109/07853890.2012.671537. Epub 2012 Apr 12.

    PubMed 22494087
  • de Lorgeril M, Salen P, Martin JL, Monjaud I, Delaye J, Mamelle N. Mediterranean diet, traditional risk factors, and the rate of cardiovascular complications after myocardial infarction: final report of the Lyon Diet Heart Study. Circulation. 1999 Feb 16;99(6):779-85. doi: 10.1161/01.cir.99.6.779.

    PubMed 9989963
  • Iaccarino Idelson P, Scalfi L, Valerio G. Adherence to the Mediterranean Diet in children and adolescents: A systematic review. Nutr Metab Cardiovasc Dis. 2017 Apr;27(4):283-299. doi: 10.1016/j.numecd.2017.01.002. Epub 2017 Jan 12.

    PubMed 28254269
  • Yusuf S, Hawken S, Ounpuu S, Dans T, Avezum A, Lanas F, McQueen M, Budaj A, Pais P, Varigos J, Lisheng L; INTERHEART Study Investigators. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet. 2004 Sep 11-17;364(9438):937-52. doi: 10.1016/S0140-6736(04)17018-9.

    PubMed 15364185
  • Wood DA, Kotseva K, Connolly S, Jennings C, Mead A, Jones J, Holden A, De Bacquer D, Collier T, De Backer G, Faergeman O; EUROACTION Study Group. Nurse-coordinated multidisciplinary, family-based cardiovascular disease prevention programme (EUROACTION) for patients with coronary heart disease and asymptomatic individuals at high risk of cardiovascular disease: a paired, cluster-randomised controlled trial. Lancet. 2008 Jun 14;371(9629):1999-2012. doi: 10.1016/S0140-6736(08)60868-5.

    PubMed 18555911

Questions about this trial

What is this clinical trial studying?

A study testing Risk Factors Modification Programme in people with Carotid Stenosis, run by Western Vascular Institute, Ireland at 1 site in Ireland.

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 15 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: status not confirmed, as of the sponsor's last update on 4 Aug 2021. 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 Ireland. 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.

Are results available for this study?

Results are not available in the source record.

How can a doctor refer a patient or contact the research team?

Contact Wael Tawfick, MB BcH,MRCSI (+ 35391542535, wael.tawfick@hse.ie), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Achieve Lifestyle modification target (time frame: 12 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 NCT03929354, which also lists 7 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 4 Aug 2021.

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