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The Effect of Tekturna on Endothelial Function and Endothelial Progenitor Cells in Patients With Early Atherosclerosis

Primary Purpose

Endothelial Dysfunction

Status
Terminated
Phase
Phase 3
Locations
United States
Study Type
Interventional
Intervention
Aliskiren
Placebo
Sponsored by
Mayo Clinic
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Endothelial Dysfunction focused on measuring Endothelial Dysfunction, Endothelial Function, Tekturna, Endothelial Peripheral Arterial Tomography (EndoPAT), Progenitor Cells, renin inhibition, endothelial progenitor cells, early atherosclerosis

Eligibility Criteria

18 Years - undefined (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  1. Age > 18 years old
  2. More than two of the following cardiovascular risk factors (determined by prescreen phone call): family history of cardiovascular disease, physical inactivity/sedentary lifestyle, obesity or overweight, family history of diabetes mellitus or hypertension, total cholesterol > 200 mg/dL, LDL > 130 mg/dL, HDL < 50 mg/dL, smoking, stress, or Triglycerides > 150 mg/dL
  3. Demonstrated endothelial dysfunction (reactive hyperemia - EndoPAT score < 2.0) at time of screening

Exclusion Criteria:

  1. Serum potassium > 5.0 mmol/L documented at any time prior to the study
  2. History of any cardiovascular event (stroke, transient ischemic attack (TIA), myocardial infarction (MI), unstable angina, coronary artery bypass grafting (CABG), percutaneous coronary intervention, hospitalization due to heart failure) during the 3 months prior to the study
  3. Hypertension or hypotension (at Randomization): any patient with Mean Seated Systolic Blood Pressure (msSBP) ≥ 170 mmHg, msSBP < 100 mmHg or Mean Seated Diastolic Blood Pressure (msDBP) ≥ 110 mmHg
  4. Congestive heart failure New York Heart Association (NYHA) class III and IV
  5. Concomitant treatment with two (2) or more renin-angiotensin-aldosterone system blocking agents, e.g. Angiotensin Converting Enzyme Inhibitor (ACEI), Angiotensin II receptor blockers (ARB) or aldosterone-antagonist
  6. Unstable serum creatinine
  7. Second (II) or third (III) degree heart block without a pacemaker
  8. Concurrent potentially life threatening arrhythmia or other uncontrolled arrhythmia
  9. Clinically significant valvular heart disease
  10. Known renal artery stenosis
  11. Any surgical or medical condition which might significantly alter the absorption, distribution, metabolism, or excretion of the study drugs including, but not limited to, any of the following:

    • History of major gastrointestinal tract surgery such as gastrectomy, gastroenterostomy, or bowel resection
    • Any history of pancreatic injury, pancreatitis or evidence of impaired pancreatic function/injury as indicated by abnormal lipase or amylase
    • Evidence of hepatic disease as determined by a history of hepatic encephalopathy, a history of cirrhosis, esophageal varices, or a history of portocaval shunt
  12. History of malignancy other than basal cell skin cancer within the past five years
  13. Any concurrent life threatening condition with a life expectancy less than 2 years
  14. History or evidence of drug or alcohol abuse within the last 12 months
  15. Any surgical or medical condition, which in the opinion of the investigator, may place the patient at higher risk from his/her participation in the study, or is likely to prevent the patient from complying with the requirements of the study or completing the study
  16. History of hypersensitivity to any of the study drugs or to medications belonging to the same therapeutic class as the study drugs as well as known or suspected contraindications to the study drugs
  17. History of noncompliance to medical regimens or unwillingness to comply with the study protocol
  18. Use of other investigational drugs at the time of enrollment, or within 30 days or 5 half-lives of enrollment, whichever is longer
  19. Any condition that in the opinion of the investigator would jeopardize the evaluation of efficacy or safety
  20. Persons directly involved in the execution of this protocol
  21. Pregnant or nursing (lactating) women
  22. Women of Child-Bearing Potential (WOCBP) unless postmenopausal for at least one year, surgically sterile or using effective methods of contraception as defined by local Health Authorities

Sites / Locations

  • Mayo Clinic in Rochester

Arms of the Study

Arm 1

Arm 2

Arm Type

Active Comparator

Placebo Comparator

Arm Label

Aliskiren

Placebo

Arm Description

150 mg Aliskiren once daily for a period of 4 months.

1 pill per day by mouth for 4 months.

Outcomes

Primary Outcome Measures

Endothelial Progenitor Cells (EPC)
Peripheral blood mononuclear cells were stained for EPC markers (cell-surface antigens CD34/CD133/KDR) and counted by flow-cytometry.
Reactive Hyperemia Index (RHI)
RHI was measured by the noninvasive endothelial peripheral arterial tomography (EndoPat) test. EndoPAT results are reported as the "Endoscore" (range 0-3); a score of 1.67 and lower indicates the need for immediate medical attention; a score between 1.68 and 2 indicates a need to reduce risk factors; a score above 2.1 indicates a healthy heart.

Secondary Outcome Measures

Systolic Blood Pressure
Diastolic Blood Pressure

Full Information

First Posted
February 8, 2010
Last Updated
January 9, 2013
Sponsor
Mayo Clinic
Collaborators
National Institute on Aging (NIA), National Heart, Lung, and Blood Institute (NHLBI), Novartis
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1. Study Identification

Unique Protocol Identification Number
NCT01067326
Brief Title
The Effect of Tekturna on Endothelial Function and Endothelial Progenitor Cells in Patients With Early Atherosclerosis
Official Title
The Effect of Tekturna on Endothelial Function and Endothelial Progenitor Cells in Patients With Early Atherosclerosis
Study Type
Interventional

2. Study Status

Record Verification Date
January 2013
Overall Recruitment Status
Terminated
Why Stopped
Novartis ended all studies regarding Aliskiren.
Study Start Date
February 2010 (undefined)
Primary Completion Date
December 2011 (Actual)
Study Completion Date
December 2011 (Actual)

3. Sponsor/Collaborators

Name of the Sponsor
Mayo Clinic
Collaborators
National Institute on Aging (NIA), National Heart, Lung, and Blood Institute (NHLBI), Novartis

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
We will study the hypothesis that long-term Tekturna treatment will improve endothelial function and the production and function of endothelial progenitor cells (EPCs) in patients with early atherosclerosis. Specifically, long-term Tekturna treatment will increase the Reactive Hyperemia Peripheral Arterial Tonometry indexes and increase the numbers and the function of circulating endothelial progenitor cells, compared to placebo, in association with a reduction in inflammation and oxidative stress.
Detailed Description
Aliskiren is a direct renin-inhibitor and may have beneficial effects on the vascular endothelium, similar to other antihypertensive therapies targeting the renin-angiotensin-aldosterone system (RAAS). The current study was designed to test the hypothesis that aliskiren improves endothelial function and increases the number of endothelial progenitor cells (EPCs) in normotensive patients with early atherosclerosis.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Endothelial Dysfunction
Keywords
Endothelial Dysfunction, Endothelial Function, Tekturna, Endothelial Peripheral Arterial Tomography (EndoPAT), Progenitor Cells, renin inhibition, endothelial progenitor cells, early atherosclerosis

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 3
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
22 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Aliskiren
Arm Type
Active Comparator
Arm Description
150 mg Aliskiren once daily for a period of 4 months.
Arm Title
Placebo
Arm Type
Placebo Comparator
Arm Description
1 pill per day by mouth for 4 months.
Intervention Type
Drug
Intervention Name(s)
Aliskiren
Other Intervention Name(s)
Tekturna, Rasilez
Intervention Description
150 mg Aliskiren once daily for a period of 4 months
Intervention Type
Drug
Intervention Name(s)
Placebo
Intervention Description
1 pill per day by mouth for 4 months
Primary Outcome Measure Information:
Title
Endothelial Progenitor Cells (EPC)
Description
Peripheral blood mononuclear cells were stained for EPC markers (cell-surface antigens CD34/CD133/KDR) and counted by flow-cytometry.
Time Frame
Baseline, 4 Months
Title
Reactive Hyperemia Index (RHI)
Description
RHI was measured by the noninvasive endothelial peripheral arterial tomography (EndoPat) test. EndoPAT results are reported as the "Endoscore" (range 0-3); a score of 1.67 and lower indicates the need for immediate medical attention; a score between 1.68 and 2 indicates a need to reduce risk factors; a score above 2.1 indicates a healthy heart.
Time Frame
Baseline, 4 Months
Secondary Outcome Measure Information:
Title
Systolic Blood Pressure
Time Frame
Baseline, 4 Months
Title
Diastolic Blood Pressure
Time Frame
Baseline, 4 Months

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Age > 18 years old More than two of the following cardiovascular risk factors (determined by prescreen phone call): family history of cardiovascular disease, physical inactivity/sedentary lifestyle, obesity or overweight, family history of diabetes mellitus or hypertension, total cholesterol > 200 mg/dL, LDL > 130 mg/dL, HDL < 50 mg/dL, smoking, stress, or Triglycerides > 150 mg/dL Demonstrated endothelial dysfunction (reactive hyperemia - EndoPAT score < 2.0) at time of screening Exclusion Criteria: Serum potassium > 5.0 mmol/L documented at any time prior to the study History of any cardiovascular event (stroke, transient ischemic attack (TIA), myocardial infarction (MI), unstable angina, coronary artery bypass grafting (CABG), percutaneous coronary intervention, hospitalization due to heart failure) during the 3 months prior to the study Hypertension or hypotension (at Randomization): any patient with Mean Seated Systolic Blood Pressure (msSBP) ≥ 170 mmHg, msSBP < 100 mmHg or Mean Seated Diastolic Blood Pressure (msDBP) ≥ 110 mmHg Congestive heart failure New York Heart Association (NYHA) class III and IV Concomitant treatment with two (2) or more renin-angiotensin-aldosterone system blocking agents, e.g. Angiotensin Converting Enzyme Inhibitor (ACEI), Angiotensin II receptor blockers (ARB) or aldosterone-antagonist Unstable serum creatinine Second (II) or third (III) degree heart block without a pacemaker Concurrent potentially life threatening arrhythmia or other uncontrolled arrhythmia Clinically significant valvular heart disease Known renal artery stenosis Any surgical or medical condition which might significantly alter the absorption, distribution, metabolism, or excretion of the study drugs including, but not limited to, any of the following: History of major gastrointestinal tract surgery such as gastrectomy, gastroenterostomy, or bowel resection Any history of pancreatic injury, pancreatitis or evidence of impaired pancreatic function/injury as indicated by abnormal lipase or amylase Evidence of hepatic disease as determined by a history of hepatic encephalopathy, a history of cirrhosis, esophageal varices, or a history of portocaval shunt History of malignancy other than basal cell skin cancer within the past five years Any concurrent life threatening condition with a life expectancy less than 2 years History or evidence of drug or alcohol abuse within the last 12 months Any surgical or medical condition, which in the opinion of the investigator, may place the patient at higher risk from his/her participation in the study, or is likely to prevent the patient from complying with the requirements of the study or completing the study History of hypersensitivity to any of the study drugs or to medications belonging to the same therapeutic class as the study drugs as well as known or suspected contraindications to the study drugs History of noncompliance to medical regimens or unwillingness to comply with the study protocol Use of other investigational drugs at the time of enrollment, or within 30 days or 5 half-lives of enrollment, whichever is longer Any condition that in the opinion of the investigator would jeopardize the evaluation of efficacy or safety Persons directly involved in the execution of this protocol Pregnant or nursing (lactating) women Women of Child-Bearing Potential (WOCBP) unless postmenopausal for at least one year, surgically sterile or using effective methods of contraception as defined by local Health Authorities
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Amir Lerman, MD
Organizational Affiliation
Mayo Clinic
Official's Role
Principal Investigator
Facility Information:
Facility Name
Mayo Clinic in Rochester
City
Rochester
State/Province
Minnesota
ZIP/Postal Code
55905
Country
United States

12. IPD Sharing Statement

Citations:
PubMed Identifier
23615219
Citation
Flammer AJ, Gossl M, Li J, Reriani M, Shonyo S, Loeffler D, Herrmann J, Lerman LO, Lerman A. Renin inhibition with aliskiren lowers circulating endothelial progenitor cells in patients with early atherosclerosis. J Hypertens. 2013 Mar;31(3):632-5. doi: 10.1097/HJH.0b013e32835c6d2d. No abstract available.
Results Reference
derived

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The Effect of Tekturna on Endothelial Function and Endothelial Progenitor Cells in Patients With Early Atherosclerosis

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