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ACE Inhibition and Novel Cardiovascular Risk Factors
This study is currently recruiting patients.
Sponsored by: | National Heart, Lung, and Blood Institute (NHLBI) |
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Information provided by: | National Heart, Lung, and Blood Institute (NHLBI) |
Purpose
To determine the effects of an angiotensin converting enzyme inhibitor (ACE inhibitor), enalapril, on multiple blood markers in 290 adults at high risk for cardiovascular disease.
Condition | Treatment or Intervention | Phase |
---|---|---|
Cardiovascular Diseases Heart Diseases Hypertension |
Drug: Enalapril |
Phase III |
MedlinePlus related topics: Circulatory Disorders; Heart Diseases; Heart Diseases--Prevention; High Blood Pressure
Study Type: Interventional
Study Design: Prevention, Randomized, Double-Blind, Placebo Control, Crossover Assignment
Study start: February 2002;
Study completion: January 2005
BACKGROUND: Angiotensin converting enzyme inhibitors (ACE inhibitors) may prevent cardiovascular events in high risk persons and improve skeletal muscle function in heart failure patients by means of mechanisms that are independent of blood pressure changes. However, there is limited knowledge of all the mechanisms underlying the therapeutic benefits of ACE inhibition. ACE inhibitors may favorably modify markers of fibrinolysis, inflammation, endothelial function, and extracellular tissue remodeling, all of which are associated with atherosclerosis and cardiovascular disease. But, clinical trial evidence on these effects is limited. In addition, polymorphisms of the ACE, angiotensinogen, PAI-1 and IL-6 genes may modify the therapeutic response to ACE inhibitors.
DESIGN NARRATIVE: This is a double-blind cross-over, randomized, placebo controlled trial in 290 persons with high cardiovascular risk to compare the effects of 6 months of treatment with enalapril and 6 months with placebo on the following primary outcomes: plasma plasminogen activator inhibitor-1 (PAI-1) antigen, C- reactive protein (CRP), interleukin-6 (IL-6) and soluble vascular cell adhesion molecule-1 (sVCAM-1). The secondary objectives are (a) to assess the effects of enalapril on IL-6/IL-6 Soluble Receptor ratio, PAI-1 activity, tissue plasminogen activator (TPA) antigen, fibrinogen, endothelin-1, TNF-alpha, soluble intercellular cell adhesion molecule-1 (sICAM-1), E-selectin, matrix metalloproteinase-1 (MMP-1) and tissue inhibitor of metalloproteinase-1 (TIMP-1); and (b) to explore the effects of ACE, angiotensinogen, PAI-1, and IL-6 gene polymorphisms on these biomarkers, and test the interaction of the gene polymorphisms with the effects of enalapril. The study will have sufficient power to detect small changes in several biomarkers compared to placebo. The assessment of these biological mechanisms will have clinical relevance for identifying the patients who may benefit the most from ACE inhibition. While the focus of the study is on novel cardiovascular risk factors, the results may also have future implications for developing new indications for ACE inhibitors, such as, for example, the prevention of age-related muscle wasting and physical disabilities in older persons, for which inflammation may be a causal factor.
Eligibility
Ages Eligible for Study: 55 Years and above, Genders Eligible for Study: Both
Criteria
Location and Contact Information
More Information
U.S. National Library of Medicine, Contact NLM Customer Service | ||||||||||||||
National Institutes of Health, Department of Health & Human Services | ||||||||||||||
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