Premature Coronary Artery Disease in Women - Risk Factors and Prognosis (PRECADIW)

January 16, 2012 updated by: Institute of Cardiology, Warsaw, Poland

Cardiovascular risk in women is systematically underestimated by both - society and physicians. Women younger than 50 years of age with acute coronary syndrome have 2x higher mortality compared with age-matched men. A number of common vascular-disease-related conditions are more frequent in women than in men. Women develop a more severe or different form of vascular disease then men. Variability of onset, relative risk, and the synergy of traditional and novel risk factors creates a challenge to physicians possibly resulting in suboptimal management and disregard in women presenting with angina symptoms.

During last 10 years the rise in coronary artery disease (CAD) prevalence in younger women is observed. Emerging data suggest a unique risk profile in women (hypoestrogenemia with adverse effects of a protracted dysmetabolic state). The risk factors assessment and the risk factors profiles in women that are associated with CAD may be different than in men and thus merit reassessment.

Purpose The primary objective of this study is to determine characteristics and prognosis of women with premature coronary artery disease and to evaluate the extent of atherosclerosis

Study Overview

Status

Completed

Conditions

Detailed Description

• Study Design Single-center, standardized, case-control study designed to assess the prevalence and significance of novel and traditional risk factors of premature coronary artery disease in women. Phase I (April 30th 2005- January 1st 2008) enrolled women with onset of symptomatic coronary artery disease before 55 years of age. The control group of 347 clinically healthy, age matched women was selected from the National Health Survey WOBASZ study (Polish Multicenter Population Study designed by Epidemiology and Cardiovascular Disease Prevention and Health Promotion Department of Institute of Cardiology) according to specifically designed questionnaire for WOBASZ study, and only subjects with negative history of CVD or negative exertional chest pain were included (Rywik S, Kupść W, Piotrowski W, et al. Wieloośrodkowe ogólnopolskie badanie stanu zdrowia ludności - projekt WOBASZ Założenia metodyczne oraz logistyka. Kardiol Pol 2005;63(supl.IV) 605:613).

Definition of premature CAD in women contained onset of coronary artery disease (myocardial infarction or coronary revascularization) before 55 years of age. Study participants are enrolled after coronary angiography and after identification and screening the age of admitted patients for acute coronary syndrome, stable angina or revascularization procedure. At the time of enrollment, participants give written informed consent for the study.

Information on demographic factors, social characterization, life style, education, anthropometric measurements, symptom characteristics and anamnesis, gynecologic history, family history on CVD and cancer, physical examination data, personal or family history of CVD, socioeconomic status, cardiovascular assessments and medication used was obtained through the use of a structured case report form questionnaire (CRF).

Additional fasting blood samples (15ml) are drawn from every individual (patients and controls) and frozen immediately at -70 for genetic study and in patients only half blood samples are centrifuged, separated, and frozen immediately at -70o after processing.

Baseline evaluation consisted of CRF data, and collection of coronary angiography, carotid ultrasonography and laboratory data.

The study protocol is approved by the Institutional Review Boards and Local Bioethics Committee.

  • Follow-up All patients are contacted at 6 months after discharge from the hospital, and then every 6 months, for at least 4 years, to assess symptom status, menstrual status and occurrence of cardiovascular events (MACE) including death, nonfatal myocardial infarction, coronary revascularization, cardiac surgery and hospitalization for unstable angina.
  • Study Endpoints

Primary Outcome Measures:

  1. To evaluate the prevalence of atherosclerosis risk factors in women with premature CAD, including family history, social, environmental, clinical, traditional and novel risk factors, menopausal status and its association with early onset of the disease as compared to matched controls.
  2. To evaluate the association of clinical factors to extent and advance of atherosclerosis
  3. To evaluate predictive role of clinical factors and in particular: impaired fasting glucose, abdominal obesity, hypertension, metabolic syndrome, inflammatory markers, coexisting inflammatory and immunologic diseases on prognosis at 1 year and long-term follow-up in terms of MACE (cardiovascular death, nonfatal MI, revascularization, hospitalization due to heart failure III/IV or acute coronary syndrome)

Secondary Outcome Measures:

  1. To evaluate predictive role of clinical factors and in particular: impaired fasting glucose, abdominal obesity, hypertension, metabolic syndrome, inflammatory markers, coexisting inflammatory and immunologic diseases on prognosis in terms of Vascular Events (MACE, hospitalization due to CAD progression, major arrhythmia, with ICD implantation, and stroke)
  2. To evaluate predictive role of clinical factors and in particular: impaired fasting glucose, abdominal obesity, hypertension, metabolic syndrome, inflammatory markers, coexisting inflammatory and immunologic diseases on prognosis in terms of components of Vascular Events and total mortality

Endpoints assessment:

Independent endpoint classification committee comprising of 2 not involved into study procedures cardiologists will review documentation of the event and classify it.

The study may have significant implications for improvement, identification and management of female patients at risk of premature atherosclerosis providing more gender-specific data for efficacy and safety of cardiovascular medication. Better scientific recognition will result in better awareness of risk and effective prevention of coronary artery disease in young females, in optimizing the delivery of heart care to population of young women and rationale for guidelines specific for women.

Study Type

Observational

Enrollment (Actual)

670

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

  • Poland
      • Warsaw, Poland, 04-628
        • Institute of Cardiology,

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

18 years to 55 years (Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

Female

Sampling Method

Non-Probability Sample

Study Population

Cases: Consecutive women with onset of evident CAD before 55 years of age (admitted to coronary angiography because of acute coronary syndrome, stable angina or revascularization procedure Controls: age-matched healthy women selected from participants examined between 2004-2006 in the National Health Survey - WOBASZ study with negative history of exertional chest pain, angina, hospitalization of revascularization procedures or coronary treatment

Description

Inclusion Criteria:

  • Patients: Consecutive women with onset of evident CAD before 55 years of age (admitted to coronary angiography because of acute coronary syndrome, stable angina or revascularization procedure)
  • agreement to participate the study
  • Controls : age-matched healthy women selected from participants examined between 2004-2006 in the National Health Survey - WOBASZ study with negative history of exertional chest pain, angina, hospitalization of revascularization procedures or coronary treatment.

Exclusion Criteria:

  • inability to give informed consent death before discharge during the index hospitalization

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

  • Observational Models: Case-Control
  • Time Perspectives: Prospective

Cohorts and Interventions

Group / Cohort
1
323 women with established coronary artery disease before 55 year of age
2
347 clinically healthy, age matched women selected from the National Health Survey WOBASZ study with negative history of CVD or negative exertional chest pain.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Time Frame
Comparison of clinical characteristics between study group and matched controls
Time Frame: 1-year (short-term), 4-year (long-term)
1-year (short-term), 4-year (long-term)
Association of clinical factors to extent and advance of atherosclerosis
Time Frame: 1-year (short-term), 4-year (long-term)
1-year (short-term), 4-year (long-term)
Predictive role of clinical factors on prognosis in terms of MACE
Time Frame: 1-year (short-term), 4-year (long-term)
1-year (short-term), 4-year (long-term)

Secondary Outcome Measures

Outcome Measure
Time Frame
Predictive role of clinical factors on prognosis in terms of Vascular Events
Time Frame: 1-year, 2-year, 3-year, 4-year
1-year, 2-year, 3-year, 4-year
Predictive role of clinical factors on prognosis in terms of components of Vascular Events and total mortality
Time Frame: 1-year, 2-year, 3-year, 4-year
1-year, 2-year, 3-year, 4-year

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Institute of Cardiology, Warsaw, Poland

Investigators

  • Principal Investigator: Barbara M Lubiszewska, Institute of Cardiology, Warsaw, Poland

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

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

April 1, 2005

Primary Completion (Actual)

June 1, 2010

Study Completion (Actual)

September 1, 2010

Study Registration Dates

First Submitted

October 15, 2007

First Submitted That Met QC Criteria

October 15, 2007

First Posted (Estimate)

October 16, 2007

Study Record Updates

Last Update Posted (Estimate)

January 18, 2012

Last Update Submitted That Met QC Criteria

January 16, 2012

Last Verified

January 1, 2012

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • 2 P05B 013 28

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

product manufactured in and exported from the U.S.

No

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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