Stop Atherosclerosis in Native Diabetics Study (SANDS)
15 giugno 2021 aggiornato da: 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.
Panoramica dello studio
Stato
Completato
Intervento / Trattamento
Descrizione dettagliata
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.
Tipo di studio
Interventistico
Iscrizione (Effettivo)
548
Fase
- Fase 4
Contatti e Sedi
Questa sezione fornisce i recapiti di coloro che conducono lo studio e informazioni su dove viene condotto lo studio.
Luoghi di studio
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Arizona
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Chinle, Arizona, Stati Uniti, 86503
- Chinle Comprehensive Health Care
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Phoenix, Arizona, Stati Uniti, 85016
- Phoenix Indian Medical Center
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Oklahoma
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Lawton, Oklahoma, Stati Uniti, 73507
- USPHS Indian Hospital
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South Dakota
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Rapid City, South Dakota, Stati Uniti, 57701
- Black Hills Center for American Indian Health
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Criteri di partecipazione
I ricercatori cercano persone che corrispondano a una certa descrizione, chiamata criteri di ammissibilità. Alcuni esempi di questi criteri sono le condizioni generali di salute di una persona o trattamenti precedenti.
Criteri di ammissibilità
Età idonea allo studio
40 anni e precedenti (Adulto, Adulto più anziano)
Accetta volontari sani
Sì
Sessi ammissibili allo studio
Tutto
Descrizione
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.
Piano di studio
Questa sezione fornisce i dettagli del piano di studio, compreso il modo in cui lo studio è progettato e ciò che lo studio sta misurando.
Come è strutturato lo studio?
Dettagli di progettazione
- Scopo principale: Prevenzione
- Assegnazione: Randomizzato
- Modello interventistico: Assegnazione parallela
- Mascheramento: Nessuno (etichetta aperta)
Armi e interventi
Gruppo di partecipanti / Arm |
Intervento / Trattamento |
|---|---|
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Nessun intervento: SANDS Control Group
Standard Treatment for blood pressure and cholesterol
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Comparatore attivo: SANDS Intervention Group
FDA approved drugs to treat blood pressure and cholesterol
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Altri nomi:
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Cosa sta misurando lo studio?
Misure di risultato primarie
Misura del risultato |
Misura Descrizione |
Lasso di tempo |
|---|---|---|
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Changing LDL Cholesterol
Lasso di tempo: 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
|
Misure di risultato secondarie
Misura del risultato |
Misura Descrizione |
Lasso di tempo |
|---|---|---|
|
Changing Blood Pressure
Lasso di tempo: 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
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Collaboratori e investigatori
Qui è dove troverai le persone e le organizzazioni coinvolte in questo studio.
Sponsor
Investigatori
- Investigatore principale: Barbara V Howard, PhD, Medstar Health Research Institute
Pubblicazioni e link utili
La persona responsabile dell'inserimento delle informazioni sullo studio fornisce volontariamente queste pubblicazioni. Questi possono riguardare qualsiasi cosa relativa allo studio.
Pubblicazioni generali
- 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.
Studiare le date dei record
Queste date tengono traccia dell'avanzamento della registrazione dello studio e dell'invio dei risultati di sintesi a ClinicalTrials.gov. I record degli studi e i risultati riportati vengono esaminati dalla National Library of Medicine (NLM) per assicurarsi che soddisfino specifici standard di controllo della qualità prima di essere pubblicati sul sito Web pubblico.
Studia le date principali
Inizio studio
1 maggio 2003
Completamento primario (Effettivo)
1 novembre 2006
Completamento dello studio (Effettivo)
1 maggio 2007
Date di iscrizione allo studio
Primo inviato
2 settembre 2005
Primo inviato che soddisfa i criteri di controllo qualità
2 settembre 2005
Primo Inserito (Stima)
7 settembre 2005
Aggiornamenti dei record di studio
Ultimo aggiornamento pubblicato (Effettivo)
7 luglio 2021
Ultimo aggiornamento inviato che soddisfa i criteri QC
15 giugno 2021
Ultimo verificato
1 giugno 2021
Maggiori informazioni
Termini relativi a questo studio
Parole chiave
Termini MeSH pertinenti aggiuntivi
- Malattie vascolari
- Malattie metaboliche
- Disturbi cerebrovascolari
- Malattie del cervello
- Malattie del sistema nervoso centrale
- Malattie del sistema nervoso
- Arteriosclerosi
- Malattie arteriose occlusive
- Disturbi del metabolismo lipidico
- Dislipidemie
- Malattia cardiovascolare
- Malattie dell'arteria carotidea
- Aterosclerosi
- Iperlipidemie
Altri numeri di identificazione dello studio
- 2000-285
- Grant # 1 U01 HL67031 (Altro numero di sovvenzione/finanziamento: NHLBI)
Queste informazioni sono state recuperate direttamente dal sito web clinicaltrials.gov senza alcuna modifica. In caso di richieste di modifica, rimozione o aggiornamento dei dettagli dello studio, contattare register@clinicaltrials.gov. Non appena verrà implementata una modifica su clinicaltrials.gov, questa verrà aggiornata automaticamente anche sul nostro sito web .