A Trial of Inflammatory Markers, Depressive Symptoms, and Heart Disease (CHIME)

A Randomized Controlled Trial of Inflammatory Markers, Depressive Symptoms, and Heart Disease

The purpose of this study is to examine the relationship between depressive symptoms and markers of inflammation, two predictors of heart disease.

Study Overview

• Status: Terminated
• Conditions: Depression; Coronary Artery Disease (CAD); Acute Coronary Syndrome (ACS)
• Intervention / Treatment: Drug: Sertraline (Zoloft); Drug: Simvastatin (Zocor)

Detailed Description

Depressive symptoms and inflammatory markers have both been proposed as measures that indicate/precede coronary artery disease (CAD). However, no controlled research study has tested the impact of these two candidate CAD risk factors within the same design to see the directionality of their influence. This study will explore if simvastatin reduces depressive symptoms and if sertraline reduces C-Reactive protein (CRP). Additionally, the recruitment process will help determine the feasibility of a larger trial, powered for significance testing. Three hundred and seventy-five participants will be consented and screened for this study. We expect forty-two otherwise healthy outpatients to have both elevated symptoms and high CRP levels, and be willing to be randomly assigned to sertraline, an antidepressant, simvastatin, a drug with anti-inflammatory properties, or a placebo for 8 weeks. Depressive symptoms and inflammatory indicators will be assessed before treatment (screening and baseline), mid-treatment (after 4 weeks), post-treatment (after 8 weeks), and a follow-up visit (after 12 weeks), using blood tests and depression interviews. We expect that both inflammation and depressive symptoms may be reduced by both medications, but the number of subjects needed to test this hypothesis is not yet known. Hence, this pilot study will be conducted. Knowledge about the inter-dependency of these two CAD risk factors allows the most promising future observational/intervention studies to be designed and conducted.

• Study Type: Interventional
• Enrollment (Actual): 7
• Phase: Phase 1

Contacts and Locations

Study Locations

• United States
  • New York
    • New York, New York, United States, 10032
      • Columbia University Department of General Medicine

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 60 years (Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

1. Age 18 - 60
2. Mild depression
3. Inflammatory markers: CRP > 2

Exclusion Criteria:

1. Non-English or Non-Spanish speakers
2. Active suicidal or homicidal ideation
3. Current alcohol or other substance abuse
4. Psychotic features
5. Current personality disorder
6. History of bipolar depressive disorder
7. Any current psychotic disorder
8. Current major depressive disorder
9. Current depression treatment or treatment within preceding 6 weeks
10. History of chronic liver and/or renal disease
11. Current use or contraindication to any of the tested medications
12. Absence of a response to a previous adequate trial of any of the tested medications
13. Pregnant or lactating women
14. History of coronary artery disease
15. Current use of statins
16. Current, regular aspirin use
17. Antibiotic use within the previous four weeks
18. History of diabetes
19. Inflammatory diseases
20. Meets NCEP guidelines for cholesterol lowering therapy

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Prevention
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Double

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: 1; Patients randomized to sertraline will receive 50 mg/d for the first 6 weeks. Based on clinical response and tolerability, the dosage will be increased to 2 tablets (100 mg/d) at the end of week 6 until the end of the study (8 weeks). If AEs occur, the dosage will be reduced by 50 mg (1 tablet) at a time, as long as a minimum daily dose of 50 mg is maintained. The psychiatry fellow will be responsible for drug administration and will see all patients weekly. All randomized patients will also be seen at the mid-treatment, post-treatment, and follow-up visits by the study psychiatrist to determine depression symptom severity (HAM-D), assess medical tolerance to the study medications, and ensure patient psychiatric safety. The study psychiatrist will be blinded to treatment allocation.	Drug: Sertraline (Zoloft); Patients randomized to sertraline will receive 50 mg/d for the first 6 weeks. Based on clinical response and tolerability, the dosage will be increased to 2 tablets (100 mg/d) at the end of week 6 until the end of the study (8 weeks). If adverse events occur, the dosage will be reduced by 50 mg (1 tablet) at a time, as long as a minimum daily dose of 50 mg is maintained.
Placebo Comparator: 2; To ensure blinding of research assessments and the patient, all medications, including the placebo, will be reformulated into a matching number of identical-appearing pills. All randomized patients will also be seen at the mid-treatment, post-treatment, and follow-up visits by the study psychiatrist to determine depression symptom severity (HAM-D), assess the medical tolerance to the study medications (including placebo), and ensure patient psychiatric safety. The study psychiatrist will be blinded to treatment allocation.	Drug: Simvastatin (Zocor); The placebo drug will be administered for 8 weeks. To ensure blinding of research assessments and the patient, all medications, including the placebo, will be reformulated into a matching number of identical-appearing pills.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
Score on Beck Depression Inventory and C-Reactive Protein Level at weeks 4, 8, and 12	3 months

Collaborators and Investigators

• Sponsor: New York State Psychiatric Institute
• Collaborators: National Alliance for Research on Schizophrenia and Depression
• Investigators: Principal Investigator: Karina W Davidson, PhD, Columbia University: Behavioral Cardiovascular Health and Hypertension Program

Study record dates

Study Major Dates

• Study Start: April 1, 2005
• Primary Completion (Actual): January 1, 2009
• Study Completion (Actual): January 1, 2009

Study Registration Dates

• First Submitted: September 15, 2005
• First Submitted That Met QC Criteria: September 15, 2005
• First Posted (Estimate): September 21, 2005

Study Record Updates

• Last Update Posted (Estimate): May 31, 2012
• Last Update Submitted That Met QC Criteria: May 30, 2012
• Last Verified: May 1, 2012

More Information

Terms related to this study

• Keywords: depression; placebo; sertraline; inflammation; randomized clinical trial; heart disease; simvastatin
• Additional Relevant MeSH Terms: Behavioral Symptoms; Myocardial Ischemia; Cardiovascular Diseases; Vascular Diseases; Arteriosclerosis; Arterial Occlusive Diseases; Coronary Disease; Heart Diseases; Depression; Coronary Artery Disease; Acute Coronary Syndrome; Physiological Effects of Drugs; Neurotransmitter Agents; Molecular Mechanisms of Pharmacological Action; Enzyme Inhibitors; Antimetabolites; Anticholesteremic Agents; Hypolipidemic Agents; Lipid Regulating Agents; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Psychotropic Drugs; Serotonin Uptake Inhibitors; Neurotransmitter Uptake Inhibitors; Membrane Transport Modulators; Serotonin Agents; Antidepressive Agents; Sertraline; Simvastatin
• Other Study ID Numbers: 4976 (Davidson)