Atherosclerosis Clinical Trial
Official title:
Aliskiren Effect on Plaque Progression In Established Atherosclerosis Using High Resolution 3D MRI (ALPINE): A Double Blind Placebo Controlled Trial
This study is being done to assess the effectiveness of short term (~9 months) Aliskiren/Placebo therapy to slow down the progression of atherosclerotic disease in thoracic and abdominal aorta. This will be checked by comparing before and after therapy magnetic resonance imaging (MRI) pictures of the aortic wall. Aliskiren is an FDA approved drug for hypertension but in this study is used for a new indication. Recent studies with animals have shown that Aliskiren therapy reduces the atherosclerotic plaque. Therefore, in this study, the investigators would like to evaluate whether the investigational drug Aliskiren, which is not FDA approved for this indication has the same beneficial effects in people with atherosclerotic disease.
Treatments and Clinic Visits:
The 36-week double-blind, randomized treatment phase of the trial is preceded by 2-week
single-blind placebo period to assess eligibility into the active treatment period,
compliance, and to confirm the baseline blood pressure values of the enrolled subjects. If
at the end of the single-blind phase, inclusion criteria will not be met, the participants
will not be allowed to continue on to the trial. If they are eligible they will undergo
baseline MRI studies after being randomized to either placebo or Aliskiren 150 mg, with an
escalation to 300 mg at 2 weeks into treatment. This dose will be maintained for the
duration of the trial. After randomization and dose escalation visits (at 2 weeks), patients
will return for scheduled clinic visits at weeks 12 and 36. Assessment of routine safety
measures including serum creatinine and potassium will be performed at pre-designated visits
(randomization, drug escalation and end-of trial). At each study visit, after having the
patient in a sitting position for 5 minutes, SBP/diastolic blood pressure will be measured 3
times in accordance with the AHA Committee Report on blood pressure determination. The
patient will be then asked to stand for 2 minutes, and a single blood pressure measurement
will be measured in the standing position. Evidence of left ventricular hypertrophy (LVH)
will be determined using the Romhilt-Estes scoring system at baseline. Specialized
measurements of plasma including insulin, glucose measures, adipokines (leptin and
adiponectin) and high- sensitivity C-reactive protein (hsCRP) will be performed at
randomization and 12 weeks into the trial. Central aortic blood pressure assessment will be
performed at randomization and end of trial/exit visits (SphygmoCor CP, AtCor Medical,
Itaska, Illinois, USA). Plasma direct renin measurements will be obtained at baseline and 12
weeks in part to assess compliance of patients with their therapy (Diasource, Belgium).
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