Cardiovascular Diseases Clinical Trial
Official title:
Pharmacogenetics of Hypertriglyceridemia in Hispanics
To study the effect of genes on lipid-lowering drug treatment in hypertriglyceridemia.
BACKGROUND:
Increased serum triglycerides are a significant independent risk factor for coronary artery
disease and myocardial infarction. Besides typical lifestyle modification, the treatment
with fibrates is standard in patients with hypertriglyceridemia. There is ample evidence
that genetic factors influence triglyceride levels. Identifying genes, which affect
triglyceride levels and moreover determining the response to fibrates is of great interest.
Hispanics are among the populations with the highest prevalence of this disease. Therefore
focusing on a high-risk population further adds to the overall significance of this study.
Identifying genes and genetic mechanisms contributing to the treatment response can lead to
new or improved treatment methods.
DESIGN NARRATIVE:
The study tests the hypothesis that differences in therapeutic effects of fibrates are
related to variations in networks of genes regulating lipoprotein metabolism. An efficient
approach for identifying and categorizing major gene variants is based on determination of
sequence haplotypes. Only Hispanics will be studied to provide a homogenous population for
this genetic study. Furthermore, Hispanics are the fastest growing ethnic group in the U.S.
and have a higher prevalence of hypertriglyceridemia than other ethnic groups. The
investigators will measure plasma triglycerides (TG), other lipids and lipoproteins, and
lipoprotein particle size before and after treatment with fenofibrate in 800 Hispanic
individuals with hypertriglyceridemia. They will reconstruct the haplotypes of 16 candidate
genes known to regulate TG metabolism and mediate the effect of fibrates. The associations
between phenotypes and major haplotypes will be analyzed in a two stage design, with the
first half of the sample serving a hypothesis-generating function. Those candidate gene
haplotypes that are found to be associated with quantitative traits and drug responses in
the first half of the sample will then be tested for confirmation in the second half. In
addition, data from the full cohort will be analyzed to identify additional pharmacogenetic
associations that may require greater statistical power. Finally, direct fine mapping will
be performed in the four most promising genes to identify the responsible variations.
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Observational Model: Case Control, Time Perspective: Prospective
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