NCT01052272

Brief Summary

The investigators hypothesize that in patients with diabetes and acute myocardial infarction (MI), Ang II type-1 receptor blockade (AT1RB) attenuates left ventricle (LV) remodeling to a greater extent than angiotensin converting enzyme (ACE) inhibitor therapy and that the addition of xanthine oxidase (XO) inhibitor, Allopurinol, results in further improvement in LV remodeling and function in the follow-up phase after MI.

Trial Health

87
On Track

Trial Health Score

Automated assessment based on enrollment pace, timeline, and geographic reach

Enrollment
72

participants targeted

Target at P50-P75 for phase_2 diabetes

Timeline
Completed

Started Jul 2005

Longer than P75 for phase_2 diabetes

Geographic Reach
1 country

1 active site

Status
completed

Health score is calculated from publicly available data and should be used for screening purposes only.

Trial Relationships

Click on a node to explore related trials.

Study Timeline

Key milestones and dates

Study Start

First participant enrolled

July 1, 2005

Completed
4.5 years until next milestone

First Submitted

Initial submission to the registry

January 15, 2010

Completed
5 days until next milestone

First Posted

Study publicly available on registry

January 20, 2010

Completed
10 months until next milestone

Primary Completion

Last participant's last visit for primary outcome

November 1, 2010

Completed
Same day until next milestone

Study Completion

Last participant's last visit for all outcomes

November 1, 2010

Completed
2.1 years until next milestone

Results Posted

Study results publicly available

December 17, 2012

Completed
Last Updated

December 17, 2012

Status Verified

November 1, 2012

Enrollment Period

5.3 years

First QC Date

January 15, 2010

Results QC Date

March 20, 2012

Last Update Submit

November 16, 2012

Conditions

Keywords

DiabetesAcute MIAng II type-1 receptor blockade (AT1RB)LV remodelingACE inhibitor therapyXO inhibitor, AllopurinolSystolic dysfunctionDiastolic dysfunctionLV dimensionsCardiac MRI

Outcome Measures

Primary Outcomes (7)

  • Left Ventricular End Diastolic Volume Indexed to Body Surface Area (LVEDV/BSA)

    LVEDV/BSA: As an indicator of heart size, the blood volume of the heart is related to the body size. The relation of heart blood volume to body size is more accurate in determining pathology because larger people require a larger heart blood volume. The values that are too high or too low indicate a diseased myocardium. This is a measure of LV Diastolic Function. Since some visits did not occur at the scheduled 6 month intervals, the results have been divided into 3-month visit intervals.

    5 visits per Participant over 2 years (about every 6 months)

  • Left Ventricular End-Diastolic Radius to Wall Thickness (LVED Radius/Wall Thickness)

    LVED Radius/Wall thickness As an indicator of heart muscle mass and heart volume chamber diameter, the end-diastolic radius indexed to end diastolic wall thickness determines whether there is an adequate amount of heart muscle to pump the heart blood volume obtained from a two-dimensional analysis. The values that are too high or too low indicate a diseased myocardium. This is a measure of LV Geometry. Since some visits did not occur at the scheduled 6 month intervals, the results have been divided into 3-month visit intervals for reporting purposes.

    5 visits per Participant over 2 years (about every 6 months)

  • Left Ventricular End-diastolic Mass Indexed to Left Ventricular End-diastolic Volume (LVED Mass/LVEDV)

    LVED Mass/LVEDV: As an indicator of heart muscle mass and heart blood volume, the mass indexed to end diastolic volume determines whether there is an adequate amount of heart muscle to pump the heart blood volume obtained from a three-dimensional analysis. The values that are too high or too low indicate a diseased myocardium. This is a measure of LV Geometry. Since some visits did not occur at the scheduled 6 month intervals, the results have been divided into 3-month visit intervals for reporting purposes.

    5 visits per Participant over 2 years (about every 6 months)

  • Left Ventricular Ejection Fraction (LVEF)

    LVEF is a calculation of heart pump function determined from the volume after complete filling minus the volume after complete contraction divided by the volume after complete filling. A value of 55% or greater is normal. This is a measure of LV Systolic Function. Since some visits did not occur at the scheduled 6 month intervals, the results have been divided into 3-month visit intervals for reporting purposes

    5 visits per Participant over 2 years (about every 6 months)

  • Left Ventricular End Systolic Volume Indexed to Body Surface Area (LVESV/BSA)

    LVESV/BSA: The end systolic volume is the blood volume of the heart at the end of contraction and is an index of the pump function of the heart. This relation to body size is more accurate in determining pathology because larger people require a larger heart blood volume. The values that are too high or too low indicate a diseased myocardium. This is a measure of LV Systolic Function. Since some visits did not occur at the scheduled 6 month intervals, the results have been divided into 3-month visit intervals.

    5 visits per Participant over 2 years (about every 6 months)

  • LV End Systolic Maximum Shortening (LVES Max Shortening)

    By identifying three points in three different planes in the heart muscle, the maximum shortening is the average of the difference between the distance between these three points at the end of filling of the heart and the end of contraction divided by the length at the end of filling times 100. The maximum shortening is a three dimensional analysis. The higher values indicate a healthy heart. This is a measure of LV Systolic Function. Since some visits did not occur at the scheduled 6 month intervals, the results have been divided into 3-month visit intervals for reporting purposes.

    5 visits per Participant over 2 years (about every 6 months)

  • Peak Early Filling Rate Normalized to EDV

    The Peak Early Filling Rate Normalized to EDV is calculated from the slope of the volume during the early filling of the heart with respect to time. The higher values indicate a very healthy heart muscle and lower values are indicative of a very stiff muscle. This is a measure of LV Diastolic Function. Since some visits did not occur at the scheduled 6 month intervals, the results have been divided into 3-month visit intervals for reporting purposes.

    5 visits per Participant over 2 years (about every 6 months)

Study Arms (4)

Ramipril

ACTIVE COMPARATOR

The starting dose of Ramipril will be 2.5 mg once daily and rapidly titrated upward to 5 mg once daily after 5 days if systolic blood pressure is greater than 100 mmHg. After one month the patient will return to clinic for blood pressure check and will be titrated up to 10 mg once daily.

Drug: Ramipril

Candesartan cilexetil

ACTIVE COMPARATOR

The starting dose of Candesartan cilexetil will be 4 mg or 8 mg once daily and doubled every 2 weeks, if systolic blood pressure is greater than 100 mmHg, to a maximum dose of 32 mg once daily. After one month the patient will return to clinic for blood pressure check and will be titrated up to 32 mg once daily.

Drug: Candesartan cilexetil

Ramipril and Allopurinol

ACTIVE COMPARATOR

The starting dose of Ramipril will be 2.5 mg once daily and rapidly titrated upward to 5 mg once daily after 5 days if systolic blood pressure is greater than 100 mmHg. After one month the patient will return to clinic for blood pressure check and will be titrated up to 10 mg once daily. It is anticipated that the starting dose of each drug will be initiated in hospital and that the second dose will be implemented prior to discharge from the hospital. The starting dose of Allopurinol is 300 mg daily.

Drug: RamiprilDrug: Allopurinol

Candesartan cilexetil and Allopurinol

ACTIVE COMPARATOR

The starting dose of Candesartan cilexetil will be 4 mg or 8 mg once daily and doubled every 2 weeks, if systolic blood pressure is greater than 100 mmHg, to a maximum dose of 32 mg once daily. After one month the patient will return to clinic for blood pressure check and will be titrated up to 32 mg once daily. The starting dose of Allopurinol is 300 mg daily.

Drug: Candesartan cilexetilDrug: Allopurinol

Interventions

The starting dose of Ramipril will be 2.5 mg once daily and rapidly titrated upward to 5 mg once daily after 5 days if systolic blood pressure is greater than 100 mmHg. After one month the patient will return to clinic for blood pressure check and will be titrated up to 10 mg once daily.

Also known as: Altace
RamiprilRamipril and Allopurinol

The starting dose of Candesartan cilexetil will be 4 mg or 8 mg once daily and doubled every 2 weeks, if systolic blood pressure is greater than 100 mmHg, to a maximum dose of 32 mg once daily. After one month the patient will return to clinic for blood pressure check and will be titrated up to 32 mg once daily.

Also known as: Atacand
Candesartan cilexetilCandesartan cilexetil and Allopurinol

The starting dose of Allopurinol is 300 mg daily.

Also known as: Altace
Candesartan cilexetil and AllopurinolRamipril and Allopurinol

Eligibility Criteria

Age21 Years+
Sexall
Healthy VolunteersNo
Age GroupsAdult (18-64), Older Adult (65+)

You may qualify if:

  • years old or older
  • MI documented by increase in troponin \> 0.78 ng/ml or CKMB ≥ 3% of total CK
  • Patients who have Type-2 diabetes defined by any one of the following:
  • Confirmed (i.e., two or more readings) fasting blood glucose \>126mg/dl; or
  • Random glucose ≥200mg/dl; or
  • hour glucose ≥200mg/dl following 75g of glucose; or
  • Current treatment with diet or oral agents directed at the control of hyperglycemia either alone or in combination with insulin; or
  • Current treatment with insulin with no prior history of diabetic ketoacidosis.

You may not qualify if:

  • Type-1 diabetes.
  • Class III or IV heart failure.
  • Cardiomyopathy (including hypertrophic and amyloidosis).
  • Congenital or pericardial diseases.
  • Intolerance to either ACE inhibitor, AT1-RB or allopurinol.
  • Renal failure with creatinine \> 2.5 mg/dl.
  • Renal artery stenosis.
  • Severe comorbidity such as liver disease or malignancy.
  • Pregnancy (negative pregnancy test and effective contraceptive methods are required prior to enrollment of females of childbearing potential (not post-menopausal or surgically sterilized).
  • Chronic steroid use.
  • Unable to understand or cooperate with protocol requirements.
  • Severe claustrophobia.
  • Presence of a pacemaker or non-removable hearing aid.
  • Presence of metal clips in the body.

Contact the study team to confirm eligibility.

Sponsors & Collaborators

Study Sites (1)

University of Alabama at Birmingham

Birmingham, Alabama, 35294-2180, United States

Location

Related Publications (39)

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    PMID: 12208801BACKGROUND
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    PMID: 11473080BACKGROUND
  • Melchior T, Kober L, Madsen CR, Seibaek M, Jensen GV, Hildebrandt P, Torp-Pedersen C. Accelerating impact of diabetes mellitus on mortality in the years following an acute myocardial infarction. TRACE Study Group. Trandolapril Cardiac Evaluation. Eur Heart J. 1999 Jul;20(13):973-8. doi: 10.1053/euhj.1999.1530.

    PMID: 10361050BACKGROUND
  • Effect of ramipril on mortality and morbidity of survivors of acute myocardial infarction with clinical evidence of heart failure. The Acute Infarction Ramipril Efficacy (AIRE) Study Investigators. Lancet. 1993 Oct 2;342(8875):821-8.

    PMID: 8104270BACKGROUND
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    PMID: 1386652BACKGROUND
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    PMID: 11574421BACKGROUND
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    PMID: 10780668BACKGROUND
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    PMID: 2156635BACKGROUND
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    PMID: 11742414BACKGROUND
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    PMID: 8742574BACKGROUND
  • Sorescu D, Griendling KK. Reactive oxygen species, mitochondria, and NAD(P)H oxidases in the development and progression of heart failure. Congest Heart Fail. 2002 May-Jun;8(3):132-40. doi: 10.1111/j.1527-5299.2002.00717.x.

    PMID: 12045381BACKGROUND
  • Pimentel DR, Amin JK, Xiao L, Miller T, Viereck J, Oliver-Krasinski J, Baliga R, Wang J, Siwik DA, Singh K, Pagano P, Colucci WS, Sawyer DB. Reactive oxygen species mediate amplitude-dependent hypertrophic and apoptotic responses to mechanical stretch in cardiac myocytes. Circ Res. 2001 Aug 31;89(5):453-60. doi: 10.1161/hh1701.096615.

    PMID: 11532907BACKGROUND
  • de Jong JW, Schoemaker RG, de Jonge R, Bernocchi P, Keijzer E, Harrison R, Sharma HS, Ceconi C. Enhanced expression and activity of xanthine oxidoreductase in the failing heart. J Mol Cell Cardiol. 2000 Nov;32(11):2083-9. doi: 10.1006/jmcc.2000.1240.

    PMID: 11040111BACKGROUND
  • Matsumoto S, Koshiishi I, Inoguchi T, Nawata H, Utsumi H. Confirmation of superoxide generation via xanthine oxidase in streptozotocin-induced diabetic mice. Free Radic Res. 2003 Jul;37(7):767-72. doi: 10.1080/1071576031000107344.

    PMID: 12911273BACKGROUND
  • Desco MC, Asensi M, Marquez R, Martinez-Valls J, Vento M, Pallardo FV, Sastre J, Vina J. Xanthine oxidase is involved in free radical production in type 1 diabetes: protection by allopurinol. Diabetes. 2002 Apr;51(4):1118-24. doi: 10.2337/diabetes.51.4.1118.

    PMID: 11916934BACKGROUND
  • Cappola TP, Kass DA, Nelson GS, Berger RD, Rosas GO, Kobeissi ZA, Marban E, Hare JM. Allopurinol improves myocardial efficiency in patients with idiopathic dilated cardiomyopathy. Circulation. 2001 Nov 13;104(20):2407-11. doi: 10.1161/hc4501.098928.

    PMID: 11705816BACKGROUND
  • Saavedra WF, Paolocci N, St John ME, Skaf MW, Stewart GC, Xie JS, Harrison RW, Zeichner J, Mudrick D, Marban E, Kass DA, Hare JM. Imbalance between xanthine oxidase and nitric oxide synthase signaling pathways underlies mechanoenergetic uncoupling in the failing heart. Circ Res. 2002 Feb 22;90(3):297-304. doi: 10.1161/hh0302.104531.

    PMID: 11861418BACKGROUND
  • Butler R, Morris AD, Belch JJ, Hill A, Struthers AD. Allopurinol normalizes endothelial dysfunction in type 2 diabetics with mild hypertension. Hypertension. 2000 Mar;35(3):746-51. doi: 10.1161/01.hyp.35.3.746.

    PMID: 10720589BACKGROUND
  • American Diabetes Association: clinical practice recommendations 1995. Diabetes Care. 1995 Jan;18 Suppl 1:1-96. No abstract available.

    PMID: 7698058BACKGROUND
  • Diez J, Querejeta R, Lopez B, Gonzalez A, Larman M, Martinez Ubago JL. Losartan-dependent regression of myocardial fibrosis is associated with reduction of left ventricular chamber stiffness in hypertensive patients. Circulation. 2002 May 28;105(21):2512-7. doi: 10.1161/01.cir.0000017264.66561.3d.

    PMID: 12034658BACKGROUND
  • Querejeta R, Varo N, Lopez B, Larman M, Artinano E, Etayo JC, Martinez Ubago JL, Gutierrez-Stampa M, Emparanza JI, Gil MJ, Monreal I, Mindan JP, Diez J. Serum carboxy-terminal propeptide of procollagen type I is a marker of myocardial fibrosis in hypertensive heart disease. Circulation. 2000 Apr 11;101(14):1729-35. doi: 10.1161/01.cir.101.14.1729.

    PMID: 10758057BACKGROUND
  • Lopez B, Querejeta R, Varo N, Gonzalez A, Larman M, Martinez Ubago JL, Diez J. Usefulness of serum carboxy-terminal propeptide of procollagen type I in assessment of the cardioreparative ability of antihypertensive treatment in hypertensive patients. Circulation. 2001 Jul 17;104(3):286-91. doi: 10.1161/01.cir.104.3.286.

    PMID: 11457746BACKGROUND
  • Cracowski JL, Tremel F, Marpeau C, Baguet JP, Stanke-Labesque F, Mallion JM, Bessard G. Increased formation of F(2)-isoprostanes in patients with severe heart failure. Heart. 2000 Oct;84(4):439-40. doi: 10.1136/heart.84.4.439. No abstract available.

    PMID: 10995421BACKGROUND
  • Mallat Z, Philip I, Lebret M, Chatel D, Maclouf J, Tedgui A. Elevated levels of 8-iso-prostaglandin F2alpha in pericardial fluid of patients with heart failure: a potential role for in vivo oxidant stress in ventricular dilatation and progression to heart failure. Circulation. 1998 Apr 28;97(16):1536-9. doi: 10.1161/01.cir.97.16.1536.

    PMID: 9593557BACKGROUND
  • Nonaka-Sarukawa M, Yamamoto K, Aoki H, Takano H, Katsuki T, Ikeda U, Shimada K. Increased urinary 15-F2t-isoprostane concentrations in patients with non-ischaemic congestive heart failure: a marker of oxidative stress. Heart. 2003 Aug;89(8):871-4. doi: 10.1136/heart.89.8.871.

    PMID: 12860861BACKGROUND
  • Mak S, Newton GE. The oxidative stress hypothesis of congestive heart failure: radical thoughts. Chest. 2001 Dec;120(6):2035-46. doi: 10.1378/chest.120.6.2035.

    PMID: 11742938BACKGROUND
  • Rouleau JL, Pitt B, Dhalla NS, Dhalla KS, Swedberg K, Hansen MS, Stanton E, Lapointe N, Packer M; Canadian Prospective RandOmized FlosequInan Longevity Evaluation Investigators. Prognostic importance of the oxidized product of catecholamines, adrenolutin, in patients with severe heart failure. Am Heart J. 2003 May;145(5):926-32. doi: 10.1016/s0002-8703(02)94782-4.

    PMID: 12766756BACKGROUND
  • Lopez Farre A, Casado S. Heart failure, redox alterations, and endothelial dysfunction. Hypertension. 2001 Dec 1;38(6):1400-5. doi: 10.1161/hy1201.099612.

    PMID: 11751725BACKGROUND
  • Heart Outcomes Prevention Evaluation Study Investigators; Yusuf S, Sleight P, Pogue J, Bosch J, Davies R, Dagenais G. Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. N Engl J Med. 2000 Jan 20;342(3):145-53. doi: 10.1056/NEJM200001203420301.

    PMID: 10639539BACKGROUND
  • Pfeffer MA, Swedberg K, Granger CB, Held P, McMurray JJ, Michelson EL, Olofsson B, Ostergren J, Yusuf S, Pocock S; CHARM Investigators and Committees. Effects of candesartan on mortality and morbidity in patients with chronic heart failure: the CHARM-Overall programme. Lancet. 2003 Sep 6;362(9386):759-66. doi: 10.1016/s0140-6736(03)14282-1.

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    PMID: 10676683BACKGROUND

MeSH Terms

Conditions

Diabetes Mellitus

Interventions

Ramiprilcandesartan cilexetilAllopurinol

Condition Hierarchy (Ancestors)

Glucose Metabolism DisordersMetabolic DiseasesNutritional and Metabolic DiseasesEndocrine System Diseases

Intervention Hierarchy (Ancestors)

Heterocyclic Compounds, 2-RingHeterocyclic Compounds, Fused-RingHeterocyclic CompoundsPurines

Results Point of Contact

Title
Louis . J. Dell'Italia, M.D
Organization
University of Alabama at Birmingham

Study Officials

  • Louis J. Dell'Italia, M.D.

    University of Alabama at Birmingham

    PRINCIPAL INVESTIGATOR

Publication Agreements

PI is Sponsor Employee
No
Restrictive Agreement
No

Study Design

Study Type
interventional
Phase
phase 2
Allocation
RANDOMIZED
Masking
NONE
Purpose
TREATMENT
Intervention Model
FACTORIAL
Sponsor Type
OTHER
Responsible Party
PRINCIPAL INVESTIGATOR
PI Title
Principal Investigator

Study Record Dates

First Submitted

January 15, 2010

First Posted

January 20, 2010

Study Start

July 1, 2005

Primary Completion

November 1, 2010

Study Completion

November 1, 2010

Last Updated

December 17, 2012

Results First Posted

December 17, 2012

Record last verified: 2012-11

Locations