- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT00000473
Do Fish Oils Prevent Restenosis Post-Coronary Angioplasty?
Study Overview
Status
Intervention / Treatment
Detailed Description
BACKGROUND:
Coronary angioplasty is a non-surgical means of mechanical coronary artery revascularization with the potential of reducing or eliminating severe coronary arterial narrowing which results in myocardial ischemia. Since its innovation, the technique of coronary angioplasty has undergone continuous refinement, so that a greater proportion of patients are now eligible for this increasingly successful procedure. All clinical syndromes associated with coronary artery disease, including chronic stable angina, silent myocardial ischemia, unstable angina, and acute myocardial infarction, have been successfully treated with this therapy, and often dramatic, favorable results are achieved. A persistent limitation of the procedure has been the development of restenosis or the recurrence of coronary arterial narrowing which usually occurs within six months of successful balloon dilatation, in spite of current treatments such as anti-platelet agents. Several clinical trials have attempted to identify pharmacologic regimens aimed at reducing the incidence of restenosis. With rare exception, these trials have failed to detect a positive effect of any drug intervention. Considering that restenosis reflects multiple factors, such as thrombosis, spasm, an exaggerated response to injury, smooth muscle cells, platelets, and components of arachidonic acid metabolism, multiple pharmacologic therapies have been employed, including aspirin, warfarin, heparin, calcium antagonists, and steroids.
Investigators have directed attention to the potential role of marine polyunsaturated fatty acids as potential inhibitors of restenosis. Dietary fish oil has been shown to inhibit platelet aggregation and stimulate thromboxane synthesis, to reduce platelet vascular interactions in atherosclerotic and injured blood vessels, and to inhibit diet-induced atherogenesis in swine and in two species of monkeys. One study has shown that dietary fish oil administered to pigs reduced platelet deposition and vasoconstriction in balloon catheter induced carotid artery lesions. In addition, fish oil reduces blood and red cell viscosity and also inhibits the function of monocytes which may be important in the pathogenesis of atherosclerosis or in the vascular response to injury.
Early reports from human studies have been mixed, with most investigations failing to demonstrate a positive effect. However, these trials have been limited to small numbers of patients and typically lacked the rigor of a randomized, controlled clinical trial with a hard endpoint and aggressive administration of fatty acids. N-3 PUFAs have been reported in humans to increase prostacyclin formation and plasma fibrinolytic activity and to reduce serum lipids, vascular reactivity, and the inflammatory potential of white blood cells at the site of vascular injury, factors potentially involved in restenosis post-PTCA. Therefore, there was some reason to believe that the addition of n-3 PUFAs to aspirin might have a greater effect upon restenosis of treated vessels than aspirin alone. The basis of this study rested with epidemiologic data from the Eskimos and Japanese that the ingestion of n-3 PUFAs derived from cold water marine sources has a favorable effect in preventing the development of coronary artery disease.
DESIGN NARRATIVE:
Randomized, double-blind. Patients at eight centers were assigned to receiving for six months a daily dietary supplement of fish oil (ten 1.0-g capsules containing 80.6 percent ethyl esters of omega-3 fatty acids providing 4.1 g eicosapentaenoic acid [EPA] and 2.8 g docosahexaenoic acid [DHA]) or to a control group receiving corn oil. The high dose of fish oil approached the intake of the Greenland Inuits and was chosen with the hope of overcoming any antagonistic effects of other fatty acids competing with those of EPA or DHA, such as arachidonic acid or saturated fats. Two weeks prior to PTCA, patients began to take the capsules. Aspirin was initiated 12 hours prior to PTCA and continued for six months. Dietary counseling was provided prior to the two week intervention. Upon admission for PTCA and one week following PTCA, expanded dietary counseling and instruction were given. Patients were telephoned monthly to reinforce dietary information which included the American Heart Association Phase I diet to reduce total fat to 30 percent of total energy. Diet was not rigidly controlled. Recruitment began in August 1989 and ended in September 1992. Patients exited from the trial upon completion of the protocol, including a final set of evaluations at six months. The primary endpoint was presence or absence of restenosis as defined by angiography six months after PTCA. The trial was extended without additional funds through June 1994 to allow data analysis.
Study Type
Phase
- Phase 3
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Men and women with coronary heart disease in the native coronary arteries. Patients were symptomatic or had 50 percent or greater stenosis as defined by coronary angiography.
Patients had not undergone prior angioplasty.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: PREVENTION
- Allocation: RANDOMIZED
- Masking: DOUBLE
Collaborators and Investigators
Investigators
- Alexander Leaf, Massachusetts General Hospital
Publications and helpful links
General Publications
- Leaf A, Jorgensen MB, Jacobs AK, Cote G, Schoenfeld DA, Scheer J, Weiner BH, Slack JD, Kellett MA, Raizner AE, et al. Do fish oils prevent restenosis after coronary angioplasty? Circulation. 1994 Nov;90(5):2248-57. doi: 10.1161/01.cir.90.5.2248.
- Timaran CH, Mantese VA, Malas M, Brown OW, Lal BK, Moore WS, Voeks JH, Brott TG; CREST Investigators. Differential outcomes of carotid stenting and endarterectomy performed exclusively by vascular surgeons in the Carotid Revascularization Endarterectomy versus Stenting Trial (CREST). J Vasc Surg. 2013 Feb;57(2):303-8. doi: 10.1016/j.jvs.2012.09.014. Epub 2012 Dec 20.
Study record dates
Study Major Dates
Study Start
Study Completion (ACTUAL)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (ESTIMATE)
Study Record Updates
Last Update Posted (ESTIMATE)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- 62
- U01HL040548-04 (NIH)
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
Clinical Trials on Myocardial Ischemia
-
Recardio, Inc.CompletedAcute Myocardial Infarction | STEMI - ST Elevation Myocardial Infarction | Acute Myocardial IschemiaNetherlands, Hungary, Austria, Poland, Belgium
-
University Hospital "Sestre Milosrdnice"CompletedSTEMI - ST Elevation Myocardial Infarction | Myocardial ReperfusionCroatia
-
University of Roma La SapienzaCompletedRosuvastatin in Preventing Myonecrosis in Elective Percutaneous Coronary Interventions (PCIs) (ROMA)Periprocedural Myocardial NecrosisItaly
-
Fundacio Privada Mon Clinic BarcelonaMiracor Medical SANot yet recruiting
-
Deutsches Herzzentrum MuenchenCompletedInfarction, MyocardialGermany
-
Lokien van NunenMaquet Cardiovascular; Stichting Toegepaste Wetenschappen (project number 11052)CompletedAcute Myocardial Infarction | Persisting Ischemia | No ReflowNetherlands
-
Barts & The London NHS TrustUniversity College, London; Queen Mary University of LondonCompletedAcute Myocardial InfarctionSwitzerland, Denmark, United Kingdom
-
Tomsk National Research Medical Center of the Russian...CompletedMyocardial Infarction | Myocardial Injury | STEMI | Myocardial NecrosisRussian Federation
-
University Hospital, ToulouseThoratec CorporationWithdrawnChronic Myocardial IschemiaFrance
-
Foundation IRCCS San Matteo HospitalFondazione Poliambulanza Istituto Ospedaliero; Azienda Ospedaliera Ordine Mauriziano... and other collaboratorsWithdrawnST-elevation Myocardial InfarctionItaly
Clinical Trials on diet, fat-restricted
-
National Heart, Lung, and Blood Institute (NHLBI)CompletedHeart Diseases | Cardiovascular Diseases | Vascular Diseases | Hypertension
-
National Cancer Institute (NCI)National Heart, Lung, and Blood Institute (NHLBI)CompletedMyocardial Ischemia | Heart Diseases | Cardiovascular Diseases | Coronary Disease | Postmenopause
-
University of North Carolina, Chapel HillNational Heart, Lung, and Blood Institute (NHLBI)CompletedMyocardial Ischemia | Heart Diseases | Cardiovascular Diseases | Coronary Disease | Thrombosis | Hyperlipoproteinemia | Coronary Heart Disease Risk Reduction
-
National Heart, Lung, and Blood Institute (NHLBI)CompletedHeart Diseases | Cardiovascular Diseases | Hypertension | Obesity | Diabetes Mellitus | Menopause | Hypercholesterolemia | Postmenopause
-
National Heart, Lung, and Blood Institute (NHLBI)CompletedHeart Diseases | Cardiovascular Diseases | Hypercholesterolemia
-
Stanford UniversityNational Heart, Lung, and Blood Institute (NHLBI)CompletedMyocardial Ischemia | Heart Diseases | Cardiovascular Diseases | Coronary Disease | Hypertension | Obesity
-
Stanford UniversityNational Heart, Lung, and Blood Institute (NHLBI)CompletedHeart Diseases | Cardiovascular Diseases | Hypercholesterolemia | Postmenopause
-
University of MinnesotaNational Heart, Lung, and Blood Institute (NHLBI)CompletedMyocardial Infarction | Myocardial Ischemia | Heart Diseases | Cardiovascular Diseases | Coronary Disease
-
University of BergenKarolinska Institutet; University of Copenhagen; Technical University of Munich; University of GlasgowRecruitingHypertension | Diabetes Mellitus, Type 2 | Insulin Resistance | Glucose Intolerance | Overweight and Obesity | Dyslipidemia Associated With Type II Diabetes MellitusNorway
-
Stanford UniversityNational Heart, Lung, and Blood Institute (NHLBI)CompletedMyocardial Ischemia | Heart Diseases | Cardiovascular Diseases | Coronary Disease | Coronary Arteriosclerosis