Coronary Artery Disease Clinical Trial
— ARTCAPOfficial title:
Aggressive Risk-Prevention Therapies for Coronary Atherosclerotic Plaque (ART-CAP)
The purpose of this study is to evaluate the role of coronary CT angiogram (CCTA) as a superior guide for the assessment of coronary artery plaque and guiding treatment decisions. The investigators also assess the impact of preventive cardiovascular drugs on the plaque to improve patient outcomes. Participants aged 18-80 years, at intermediate or high-risk for coronary artery disease, with non-obstructive plaque on initial CCTA, will be enrolled in this study. They will be randomized into Standard of Care (SOC) vs. Aggressive Therapy (AT) groups. Both groups will undergo dietary and lifestyle interventions. Follow-up will consist of blood tests and clinic visits at baseline, 9 months, and 18 months. The second CCTA will be performed at 18 months to assess the change in plaque burden, characteristics, ischemia and pericoronary/epicardial fat.
Status | Recruiting |
Enrollment | 200 |
Est. completion date | January 31, 2029 |
Est. primary completion date | January 31, 2029 |
Accepts healthy volunteers | No |
Gender | All |
Age group | 18 Years to 80 Years |
Eligibility | Inclusion Criteria: Non-obstructive atherosclerotic coronary artery plaque (stenosis of 0-39% or stenosis of 40-69% with FFR-CT >0.8) in a major epicardial vessel > 2 mm in diameter. Exclusion Criteria: 1. coronary/PAD/carotid revascularization or ischemic stroke or TIA within 6 months prior to enrollment 2. Valvular heart disease of moderate or worse severity or requiring interventional procedures or surgery 3. LVEF <35% in the past 12 months 4. Pulmonary hypertension with PASP>50 mm Hg in the past 12 months 5. Myocarditis or pericarditis in the past 12 months 6. Known Cardiomyopathy (hypertrophic, infiltrative, restrictive, dilated, etc.) 7. Heart failure NYHA class 3 or 4 8. Hospitalization for heart failure in the preceding 6 months 9. Life expectancy of <1 year 10. An organ-transplant recipient or if felt to require listing for solid organ transplantation during study status 11. Inability to give informed consent 12. Active malignancy (except basal cell skin cancer) 13. Cirrhosis 14. ESRD 15. Pregnancy or planning to conceive during the study period 16. Known intolerance or perceived contraindication to any of the study drugs during the study period including statins or aspirin if indicated 17. eGFR<30 ml/min/m2 18. Inability to receive iodinated contrast for CCTA 19. Chronic immunosuppression therapy 20. Uncontrolled psychiatric illness |
Country | Name | City | State |
---|---|---|---|
United States | University of Louisville School of Medicine, Division of Cardiovascular Diseases | Louisville | Kentucky |
Lead Sponsor | Collaborator |
---|---|
University of Louisville |
United States,
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Primary | Plaque quantification | Quantification of plaque including total plaque, calcified plaque, non-calcified plaque, and partially calcified plaque. Units: mm3 | Baseline, 18 months | |
Primary | Characterization of plaque to evaluate for high-risk features - positive remodeling | Characterization of plaque to evaluate for high-risk features - positive remodeling Units: no units (yes or no) | Baseline, 18 months | |
Primary | Quantification of stenosis | Quantification of stenosis by using CT-FFR. Unit: percentage | Baseline, 18 months | |
Primary | Quantification of pericoronary fat attenuation. | Quantification of pericoronary and epicardial fat attenuation. Unit: Fat attenuation index [ranging from -190 to -30 Hounsfield units (HU)] | Baseline, 18 months | |
Primary | Characterization of plaque to evaluate for high-risk features - low CT attenuation | Characterization of plaque to evaluate for high-risk features - low CT attenuation Units: no units (yes or no) | Baseline, 18 months | |
Primary | Characterization of plaque to evaluate for high-risk features - napkin-ring sign | Characterization of plaque to evaluate for high-risk features - napkin-ring sign Units: no units (yes or no) | Baseline, 18 months | |
Primary | Quantification of epicardial fat attenuation. | Quantification of epicardial fat attenuation. Unit: Fat attenuation index [ranging from -190 to -30 Hounsfield units (HU)] | Baseline, 18 months | |
Secondary | Major adverse cardiac and cardiovascular events (MACCE) | Number of participants with adjusted events including non-fatal myocardial infarction, stroke, transient ischemic attack, urgent revascularization, cardiovascular hospitalization, hospitalization for heart failure, and cardiovascular death.
Unit: number of events |
5 years | |
Secondary | Polygenic risk score (PRS) | Polygenic risk score (PRS) to estimate the participant's genetic susceptibility for coronary artery disease, assessed via blood draw.
Unit: No units (weighted score ranging from 0-100) |
Baseline | |
Secondary | Next generation sequencing (NGS) | Next generation sequencing (NGS) to identify mutations associated with coronary artery disease, assessed via blood draw.
Unit: Mutation in disease-genes |
Baseline | |
Secondary | Change in Lipoprotein (a) | Change in Lipoprotein (a) level as assessed via blood draw. Unit: nmol/L | Baseline, 9 and 18 months | |
Secondary | Change in myeloperoxidase (MPO) activity | Change in myeloperoxidase (MPO) activity, as assessed via blood draw. Unit: µU/mg | Baseline, 9 and 18 months | |
Secondary | Change in trimethylamine-N-oxide (TMAO) levels | Change in trimethylamine-N-oxide (TMAO) levels, assessed via blood draw. Unit: µM | Baseline, 9 and 18 months | |
Secondary | Change in lipoprotein-associated phospholipase A2 (Lp-PLA2) levels | Change in lipoprotein-associated phospholipase A2 (Lp-PLA2) levels, as assessed by blood draw.
Unit: ng/mL |
Baseline, 9 and 18 months | |
Secondary | Change in interleukin-6 (IL-6) levels | Change in interleukin-6 (IL-6) levels, as assessed by blood draw. Unit: pg/mL | Baseline, 9 and 18 months | |
Secondary | Change in high sensitivity C-creative protein (HS-CRP) levels | Change in high sensitivity C-creative protein (HS-CRP) levels as assessed by blood draw.
Units: mg/mL |
Baseline, 9 and 18 months | |
Secondary | Buffy coat for chromatin immunoprecipitation (ChIP) | Buffy coat for chromatin immunoprecipitation (ChIP) as assessed by blood draw. Unit: Genomic locations of binding of various proteins involved in coronary plaque formation | Baseline, 9 and 18 months | |
Secondary | Change in high sensitivity Troponin (HS-Tn) | Change in high sensitivity Troponin (HS-Tn), as assessed by blood draw. Unit: ng/mL | Baseline, 9 and 18 months | |
Secondary | Change in natriuretic peptide (BNP, NT-pro BNP | Change in natriuretic peptide (BNP, NT-pro BNP), as assessed by blood draw. Unit: pg/mL | Baseline, 9 and 18 months | |
Secondary | Change in levels of open reading frame 1 protein (ORF1p) | Change in levels of open reading frame 1 protein (ORF1p), as assessed by blood draw using enzyme-linked immunosorbent assay (ELISA) or western blotting.
Unit: µg/mL |
Baseline, 9 and 18 months |
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