- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT00147251
Stop Atherosclerosis in Native Diabetics Study (SANDS)
June 15, 2021 updated by: Cynthia West
Compared to standard treatment goals achieving lower targets for LDL cholesterol (bad cholesterol) and blood pressure in people with diabetes will slow the progression of atherosclerosis as measured by carotid artery thickness, and reduce clinical cardiovascular events such as heart attacks and strokes.
This study is a randomized 3-year trial.
The primary endpoint will be a combination of various measures of the carotid artery, (which is an easy, non-invasive way to detect cardiovascular disease) and events such as heart attacks and strokes.
The study will also look at secondary endpoints such as how well the heart pumps, fat,protein and inflammatory markers in the blood,and kidney function.
The study enrolled 549 American Indian men and women with diabetes, > 40 years of age and is being conducted in four field centers involving Indian Health Service/Tribal primary care facilities in Phoenix/Sacaton, Arizona; Chinle, Arizona; Rapid City/Pine Ridge, South Dakota; and Lawton, Oklahoma, with input from American Indian physicians and community members.
Study Overview
Status
Completed
Intervention / Treatment
Detailed Description
Diabetes incidence is increasing rapidly in the United States.
Diabetes increases the risk for CVD, the major cause of death in diabetic individuals.
The conventional cardiovascular risk factors of hyperlipidemia and hypertension add to the progression of diabetic vascular disease.
Appropriate treatment targets for LDL-C and blood pressure in diabetic individuals are currently being debated.
The Stop Atherosclerosis in Native Diabetics Study is a randomized, open label, 3-year, clinical trial to examine the effects of aggressive LDL-C (goal < 70 mg/dL) and BP (goal < 115/75 mm Hg) reduction versus the standard goals of < 100 mg/dL for LDL-C and < 130/85 mmHg for BP.
Five hundred forty-nine American Indian men and women > age 40 with type 2 diabetes were randomized to one of two groups.
Lipids and BP are managed using FDA-approved medications in an algorithmic approach.
The presence and progression of atherosclerosis are evaluated by carotid ultrasonography; echocardiography assesses cardiac function.
The primary endpoint is the composite outcome of change in carotid artery intimal medial thickness and fatal/nonfatal cardiovascular events.
These outcomes are combined by using a ranked analysis for carotid thickness and assigning a "worst rank" for a cardiovascular event.
Secondary endpoints include carotid plaque score, left ventricular geometry and function, serum CRP, and safety measures.
Unique aspects of the study design and analysis plan involve changes during the trial of LDL-C treatment goals for participants with baseline or incident CVD in the conventional group, because of changes in the standard of care, and the use of a composite outcome.
Study results will be valuable in understanding the effects of aggressive risk factor reduction on atherosclerosis burden and cardiac function in diabetic individuals in all U.S. populations and will provide evidence for determining optimal LDL-C and BP treatment goals for diabetic patients.
Study Type
Interventional
Enrollment (Actual)
548
Phase
- Phase 4
Contacts and Locations
This section provides the contact details for those conducting the study, and information on where this study is being conducted.
Study Locations
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-
Arizona
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Chinle, Arizona, United States, 86503
- Chinle Comprehensive Health Care
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Phoenix, Arizona, United States, 85016
- Phoenix Indian Medical Center
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Oklahoma
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Lawton, Oklahoma, United States, 73507
- USPHS Indian Hospital
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South Dakota
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Rapid City, South Dakota, United States, 57701
- Black Hills Center for American Indian Health
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-
Participation Criteria
Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.
Eligibility Criteria
Ages Eligible for Study
40 years and older (Adult, Older Adult)
Accepts Healthy Volunteers
Yes
Genders Eligible for Study
All
Description
Inclusion Criteria:
- American Indian men and women 40 years of age or older
- Type 2 DM (according to 1997 ADA criteria and/or previously diagnosed by former ADA or WHO criteria): fasting plasma glucose >= 7.0 mmol/L (126 mg/dL) or 2-hour glucose >= 11.0 mmol/L (>200 mg/dL) after a 75-gram oral glucose tolerance test.
- LDL cholesterol >= 100 mg/dL. within the previous 12 months.
- Systolic BP >= 130 mm Hg. within the previous 12 months.
Exclusion Criteria:
- New York Heart Association Stage III- IV congestive heart failure.
- SBP >180 mmHg (2% of population) or patients with known causes of hypertension.
- History of angioedema.
- Any medical condition that study physicians believe would interfere with study participation or evaluation of results.
- Mental incapacity and/or cognitive impairment on the part of the patient that would preclude adequate understanding of, or cooperation with, the study protocol.
- Serum hepatic transaminase levels 2X the upper limit of normal.
- Participation in any clinical trial of any investigational medication within 3 months prior to this trial.
- Renal insufficiency as indicated by serum creatinine >2.0 for women and >2.4 for men.
- Diagnosis of primary hyperlipidemia in medical record.
- Secondary hypercholesterolemia due to hypothyroidism or nephrotic syndrome. Patients on stable doses of thyroid replacement therapy will be eligible.
- Presence of malignancy or history of any cancer except skin cancer within the past 5 years.
- Pregnancy or lactation. Premenopausal women will be requested to use birth control methods throughout the study and provided educational materials about the risks of using the study medications during pregnancy.
- Unable to obtain quantifiable carotid measure during screening examination.
- Concomitant long term use of cyclosporins (Sandimmune), macrolide antibiotics (erythromycin -many generic and brand name forms, clarithromycin, Biaxin, and Zithromax), azole antifungals (itraconazole-Sporanox, ritonavir, Norvir, and nelfinavir (Viracept).
Orthostatic hypotension as defined by the following:
- The individual has a measured fall of >20 mmHg in systolic BP upon standing associated with symptoms lasting more than one minute (or severe symptoms that would not allow further lowering of BP)
- The standing systolic blood pressure is less than 90 mm.
- Triglyceride level >350 mg/dl.
- Severe aortic stenosis with valve area <=1.0 square cm.
Study Plan
This section provides details of the study plan, including how the study is designed and what the study is measuring.
How is the study designed?
Design Details
- Primary Purpose: Prevention
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
No Intervention: SANDS Control Group
Standard Treatment for blood pressure and cholesterol
|
|
Active Comparator: SANDS Intervention Group
FDA approved drugs to treat blood pressure and cholesterol
|
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Changing LDL Cholesterol
Time Frame: 36 months
|
LDL cholesterol intervention to lower targets than are currently recommended to retard atherosclerosis measured by LDL-C mg/dL. Scale: LDL cholesterol levels should be less than 100 mg/dL |
36 months
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Changing Blood Pressure
Time Frame: 36 month follow-up
|
Treatment of blood pressure to prevent/reduce diseases of heart and blood vessels. Measured by mmHG. Normal values should be below 120/80 mm Hg. |
36 month follow-up
|
Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Sponsor
Investigators
- Principal Investigator: Barbara V Howard, PhD, MedStar Health Research Institute
Publications and helpful links
The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.
General Publications
- Roman MJ, Howard BV, Howard WJ, Mete M, Fleg JL, Lee ET, Devereux RB. Differential impacts of blood pressure and lipid lowering on regression of ventricular and arterial mass: the Stop Atherosclerosis in Native Diabetics Trial. Hypertension. 2011 Sep;58(3):367-71. doi: 10.1161/HYPERTENSIONAHA.111.172486. Epub 2011 Jul 25.
- Fleg JL, Mete M, Howard BV, Umans JG, Roman MJ, Ratner RE, Silverman A, Galloway JM, Henderson JA, Weir MR, Wilson C, Stylianou M, Howard WJ. Effect of statins alone versus statins plus ezetimibe on carotid atherosclerosis in type 2 diabetes: the SANDS (Stop Atherosclerosis in Native Diabetics Study) trial. J Am Coll Cardiol. 2008 Dec 16;52(25):2198-205. doi: 10.1016/j.jacc.2008.10.031.
- Howard BV, Roman MJ, Devereux RB, Fleg JL, Galloway JM, Henderson JA, Howard WJ, Lee ET, Mete M, Poolaw B, Ratner RE, Russell M, Silverman A, Stylianou M, Umans JG, Wang W, Weir MR, Weissman NJ, Wilson C, Yeh F, Zhu J. Effect of lower targets for blood pressure and LDL cholesterol on atherosclerosis in diabetes: the SANDS randomized trial. JAMA. 2008 Apr 9;299(14):1678-89. doi: 10.1001/jama.299.14.1678.
Study record dates
These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.
Study Major Dates
Study Start
May 1, 2003
Primary Completion (Actual)
November 1, 2006
Study Completion (Actual)
May 1, 2007
Study Registration Dates
First Submitted
September 2, 2005
First Submitted That Met QC Criteria
September 2, 2005
First Posted (Estimate)
September 7, 2005
Study Record Updates
Last Update Posted (Actual)
July 7, 2021
Last Update Submitted That Met QC Criteria
June 15, 2021
Last Verified
June 1, 2021
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- 2000-285
- Grant # 1 U01 HL67031 (Other Grant/Funding Number: NHLBI)
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.
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