Combined Effects of Non-statin Treatments on Apolipoprotein A-I Up-Regulation (CENTAUR): A Feasibility Study (CENTAUR)

This is an interventional treatment trial for Dyslipidemia focused on measuring Low HDL cholesterol, High triglycerides, niacin, fibrate Read More

Inclusion Criteria:

1. Men/women aged 18-80 years.

2. Low HDL-C, adjusted for baseline statin use

   1. Not on statin: Men with HDL <= 40 or women with HDL <= 50 mg/dL
   2. On statin: Men with HDL <= 42 or women with HDL <= 52 mg/dL
3. TG/HDL ratio >= 3.5
4. Able to understand and agree to informed consent
5. Women of child-bearing age must test negative on a urine pregnancy test and agree to use reliable birth control during the study and for 1 month after last dose of study drugs. Reliable methods include oral contraceptives, a barrier method, intrauterine device, partner with vasectomy, or abstinence.
6. Willing to be available for study duration and follow study procedures

Exclusion Criteria:

1. Subjects with following lipoprotein disorders:

   1. Patients on high-potency lipid-lowering regimen, defined as two or more prescription lipid-altering medications (excluding fish oils) where one is a high-dose statin (40 mg/day of rosuvastatin, 80 mg/day of other approved statins). Those on combination therapy with a lower statin dose or those taking high-dose statin monotherapy (excluding fish oils) may participate. Patients will switch to atorvastatin 10 mg and/or wash off other lipid medications to participate
   2. LDL > 190 mg/dL
   3. TG > 750 mg/dL or pancreatitis from triglyceridemia, regardless of current TG levels
   4. Dysbetalipoproteinemia (VLDL/TG > 0.3 -AND- TG > 200 mg/dL).

2. Use of non-statin lipid therapy prior to study initiation is exclusionary if (n.b. washout of non-statins is permitted):

   1. Niacin > 250 mg/ day within 6 weeks: Advicor, Niaspan, Niacor, Simcor, Slo-Niacin, or supplemental niacin
   2. Fibrates within 12 weeks: fenofibrate (Antara, Lofibra, Tricor, Triglide), gemfibrozil (Lopid), or clofibrate
   3. Enterically active drugs within 4 weeks: colestipol, cholestyramine, colesevelam, ezetimibe, orlistat.
   4. Red yeast rice during the treatment phase of the study (i.e. must be switched to study statin)
   5. Fish oil > 2 g/day within 4 weeks: Lovaza (née Omacor), numerous supplements
   6. Altered dose of a selective estrogen receptor modulator (SERM) within 4 weeks
3. Intolerance to statin, fibrate, aspirin, deuterated leucine, or niacin
4. Contraindications to medications, including chronic muscle disease, history of rhabdomyolysis, moderate-severe gout, severe peptic ulcer disease, bleeding disorders, and aspirin-sensitive asthma.
5. Diabetics, or fasting glucose > 110 mg/dL on two different days during screening, or use of anti-diabetic medications within 6 weeks of screening visit
6. Chronic renal insufficiency, nephrotic syndrome, or current serum creatinine > 2.5 mg/dL, or GFR < 60 mL/min/1.73m2 by the MDRD equation.
7. Aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP), total bilirubin > 2 X the upper limit of normal (ULN), albumin of < 2.5 mg/dL, prothrombin time (PT) > 1.5 X ULN, partial thromboplastin time (PTT) > 1.5 X ULN, or current active hepatobiliary disease
8. Hemoglobin (Hgb) < 10 mg/dL
9. Weight < 110 lbs
10. Use of an investigational drug within 6 weeks prior to screening visit
11. Major surgery within the previous 6 weeks, or anticipated major surgery during course of study, or any history of organ transplant
12. Non-skin malignancy within previous 5 years
13. Drug abuse within past 3 years, or regular alcohol use >14 drinks/week
14. Women who are pregnant, plan to conceive, or breast-feed
15. Any serious or unstable medical or psychological conditions that, in investigator's opinion would compromise subject safety or successful participation.
16. Currently adhering to, planning to adhere to or used within 3 months prior to screening, supplements intended for weight loss or adopt diets with aggressive carbohydrate restrictions, such as but not limited to Atkins or South Beach diets.
17. Currently taking Vitamin A supplements (multivitamins allowed)(washout permitted)

18. Excluded concomitant medications

    1. Immunosuppressants within 2 months prior to screening or are likely to require such treatment during the course of the study
    2. Warfarin.
19. Disinclination to dairy products (e.g. inviolable dietary restrictions or lactose intolerance to an 8oz glass of milk despite lactase supplementation) Lactase supplementation is allowed during the study.
20. Regular consumers of grapefruit juice, or currently taking medications metabolized by CYP 3A4 (cyclosporine, itraconazole, ketoconazole, erythromycin, clarithromycin, telithromycin, HIV protease inhibitors, and nefazodone)
21. History of pancreatitis or gallbladder disease
22. History of coronary heart disease
23. History of intolerance/adverse reaction to heparin or women who have dysfunctional uterine bleeding
24. Thrombocytopenia at screening
25. History of intracerebral or significant GI bleed
26. Subjects doing regular strenuous activity or have a CK > 3x ULN at screening