Stop Atherosclerosis in Native Diabetics Study (SANDS)
2021년 6월 15일 업데이트: 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.
연구 개요
상태
완전한
정황
상세 설명
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.
연구 유형
중재적
등록 (실제)
548
단계
- 4단계
연락처 및 위치
이 섹션에서는 연구를 수행하는 사람들의 연락처 정보와 이 연구가 수행되는 장소에 대한 정보를 제공합니다.
연구 장소
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Arizona
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Chinle, Arizona, 미국, 86503
- Chinle Comprehensive Health Care
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Phoenix, Arizona, 미국, 85016
- Phoenix Indian Medical Center
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Oklahoma
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Lawton, Oklahoma, 미국, 73507
- USPHS Indian Hospital
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South Dakota
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Rapid City, South Dakota, 미국, 57701
- Black Hills Center for American Indian Health
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참여기준
연구원은 적격성 기준이라는 특정 설명에 맞는 사람을 찾습니다. 이러한 기준의 몇 가지 예는 개인의 일반적인 건강 상태 또는 이전 치료입니다.
자격 기준
공부할 수 있는 나이
40년 이상 (성인, 고령자)
건강한 자원 봉사자를 받아들입니다
예
연구 대상 성별
모두
설명
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.
공부 계획
이 섹션에서는 연구 설계 방법과 연구가 측정하는 내용을 포함하여 연구 계획에 대한 세부 정보를 제공합니다.
연구는 어떻게 설계됩니까?
디자인 세부사항
- 주 목적: 방지
- 할당: 무작위
- 중재 모델: 병렬 할당
- 마스킹: 없음(오픈 라벨)
무기와 개입
참가자 그룹 / 팔 |
개입 / 치료 |
|---|---|
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간섭 없음: SANDS Control Group
Standard Treatment for blood pressure and cholesterol
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활성 비교기: SANDS Intervention Group
FDA approved drugs to treat blood pressure and cholesterol
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다른 이름들:
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연구는 무엇을 측정합니까?
주요 결과 측정
결과 측정 |
측정값 설명 |
기간 |
|---|---|---|
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Changing LDL Cholesterol
기간: 36 months
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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
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2차 결과 측정
결과 측정 |
측정값 설명 |
기간 |
|---|---|---|
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Changing Blood Pressure
기간: 36 month follow-up
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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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공동 작업자 및 조사자
여기에서 이 연구와 관련된 사람과 조직을 찾을 수 있습니다.
스폰서
수사관
- 수석 연구원: Barbara V Howard, PhD, MedStar Health Research Institute
간행물 및 유용한 링크
연구에 대한 정보 입력을 담당하는 사람이 자발적으로 이러한 간행물을 제공합니다. 이것은 연구와 관련된 모든 것에 관한 것일 수 있습니다.
일반 간행물
- 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.
연구 기록 날짜
이 날짜는 ClinicalTrials.gov에 대한 연구 기록 및 요약 결과 제출의 진행 상황을 추적합니다. 연구 기록 및 보고된 결과는 공개 웹사이트에 게시되기 전에 특정 품질 관리 기준을 충족하는지 확인하기 위해 국립 의학 도서관(NLM)에서 검토합니다.
연구 주요 날짜
연구 시작
2003년 5월 1일
기본 완료 (실제)
2006년 11월 1일
연구 완료 (실제)
2007년 5월 1일
연구 등록 날짜
최초 제출
2005년 9월 2일
QC 기준을 충족하는 최초 제출
2005년 9월 2일
처음 게시됨 (추정)
2005년 9월 7일
연구 기록 업데이트
마지막 업데이트 게시됨 (실제)
2021년 7월 7일
QC 기준을 충족하는 마지막 업데이트 제출
2021년 6월 15일
마지막으로 확인됨
2021년 6월 1일
추가 정보
이 연구와 관련된 용어
키워드
추가 관련 MeSH 약관
기타 연구 ID 번호
- 2000-285
- Grant # 1 U01 HL67031 (기타 보조금/기금 번호: NHLBI)
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