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Clinical Trial Details — Status: Completed

Administrative data

NCT number NCT02679261
Other study ID # BICATOR
Secondary ID
Status Completed
Phase Phase 3
First received
Last updated
Start date June 2016
Est. completion date February 2021

Study information

Verified date February 2021
Source Hospital Universitari Vall d'Hebron Research Institute
Contact n/a
Is FDA regulated No
Health authority
Study type Interventional

Clinical Trial Summary

Bicuspid Aortic Valve (BAV) is the most common congenital heart disease affecting 1-2% of the population. The aortic dilation and aortic valve degeneration are common complications in patients with BAV. Statins have shown a reduction in the expression of metalloproteinases of the extracellular matrix observed in aortic aneurisms. Several retrospective studies have suggested the benefit of the statins to reduce aortic dilation in patients with BAV. Moreover, although statins did not show to be useful in the progression of aortic stenosis, different studies have suggested a higher profit when the valve affection is not severe. The objective of this study is to determine whether atorvastatin is effective at reducing the progression of aortic dilation in patients with BAV.


Description:

BICATOR is a multicentre (8 centres), randomised, double-blind and placebo-controlled clinical trial aimed at evaluating the effect of atorvastatin in reducing progression of aortic dilation in patients with BAV. The primary outcome is to determine whether atorvastatin is effective in reducing aortic dilation in BAV and secondary outcome is to define if atorvastatin treatment slows the progression of aortic valve degeneration (valve calcification) in a 3 year follow-up period. 220 patients will be included (110 atorvastatin - 110 placebo).


Recruitment information / eligibility

Status Completed
Enrollment 220
Est. completion date February 2021
Est. primary completion date February 2021
Accepts healthy volunteers No
Gender All
Age group 18 Years and older
Eligibility Inclusion Criteria: - Patients = 18 years old with BAV confirmed by transthoracic echocardiography (in case of doubts other techniques will be required: transesophageal echocardiography or CT to confirm diagnosis). - Valve dysfunction only moderate: in case of aortic stenosis with average gradient < 30 mmHg and in case of aortic regurgitation a vena contracta < 7 mm or a jet with < 10 mm. - Aortic valve not show severe calcification by transthoracic echocardiography. - Ascending aortic diameter (Valsalva sinus or tubular ascending aorta) = 50 mm. - The patient must give the consent form signed. Exclusion Criteria: - Patients younger than 18. - Patients with uncontrolled hypertension and a history or risk of diabetes mellitus. - Patients who receive statins treatment or other lipid lowering drug or if they have indication to be treated according to the current clinical practice guidelines. - Previous cardiac surgery or any surgery of other segments of the aorta. - Previous aortic dissection and/or aortic coarctation. - NYHA functional class III or IV. - Presence or antecedent of liver failure (transaminase > 2 fold the superior limit of normal levels according to local laboratory), renal failure (creatinine clearance < 30ml/min or creatinine > 2.5mg/dl), myopathy or creatine kinase levels > 5 fold the superior limit of normality, or other gastrointestinal, hematologic or endocrine diseases or any other situation that according to the investigator criteria could affect the study treatment evaluation. - Hypersensitivity, intolerance or contraindication to any component of the study drug or to the contrast used in CT. - Pregnancy, breastfeeding or desire for pregnancy during the study period. A negative pregnancy test (negative gonadotropin) will be required in all fertile women to participate in the study. - Participation in another drug study.

Study Design


Related Conditions & MeSH terms


Intervention

Drug:
Atorvastatin
Oral administration atorvastatin 20 mg per day
Placebo
Oral administration placebo

Locations

Country Name City State
Spain Hospital Universitari Germans Trias i Pujol Badalona Barcelona
Spain Hospital Vall d'Hebron Barcelona
Spain Hospital General Universitario Gregorio Marañón Madrid
Spain Hospital Universitario 12 de Octubre Madrid
Spain Hospital Universitario Virgen de la Victoria Málaga
Spain Hospital Clínico Universitario Virgen de la Arrixaca Murcia
Spain Hospital Universitari Sant Joan de Reus Reus Tarragona
Spain Hospital Universitario Virgen de la Macarena Sevilla
Spain Hospital Clínico Universitario de Valladolid Valladolid
Spain Hospital Universitario de Vigo Vigo Pontevedra

Sponsors (1)

Lead Sponsor Collaborator
Hospital Universitari Vall d'Hebron Research Institute

Country where clinical trial is conducted

Spain, 

References & Publications (13)

Antonini-Canterin F, Hîrsu M, Popescu BA, Leiballi E, Piazza R, Pavan D, Ginghina C, Nicolosi GL. Stage-related effect of statin treatment on the progression of aortic valve sclerosis and stenosis. Am J Cardiol. 2008 Sep 15;102(6):738-42. doi: 10.1016/j.amjcard.2008.04.056. Epub 2008 Jun 26. — View Citation

Chan KL, Teo K, Dumesnil JG, Ni A, Tam J; ASTRONOMER Investigators. Effect of Lipid lowering with rosuvastatin on progression of aortic stenosis: results of the aortic stenosis progression observation: measuring effects of rosuvastatin (ASTRONOMER) trial. Circulation. 2010 Jan 19;121(2):306-14. doi: 10.1161/CIRCULATIONAHA.109.900027. Epub 2010 Jan 4. — View Citation

Cowell SJ, Newby DE, Prescott RJ, Bloomfield P, Reid J, Northridge DB, Boon NA; Scottish Aortic Stenosis and Lipid Lowering Trial, Impact on Regression (SALTIRE) Investigators. A randomized trial of intensive lipid-lowering therapy in calcific aortic stenosis. N Engl J Med. 2005 Jun 9;352(23):2389-97. — View Citation

Crisby M, Nordin-Fredriksson G, Shah PK, Yano J, Zhu J, Nilsson J. Pravastatin treatment increases collagen content and decreases lipid content, inflammation, metalloproteinases, and cell death in human carotid plaques: implications for plaque stabilization. Circulation. 2001 Feb 20;103(7):926-33. — View Citation

Dichtl W, Alber HF, Feuchtner GM, Hintringer F, Reinthaler M, Bartel T, Süssenbacher A, Grander W, Ulmer H, Pachinger O, Müller S. Prognosis and risk factors in patients with asymptomatic aortic stenosis and their modulation by atorvastatin (20 mg). Am J Cardiol. 2008 Sep 15;102(6):743-8. doi: 10.1016/j.amjcard.2008.04.060. Epub 2008 Jul 2. — View Citation

Goel SS, Tuzcu EM, Agarwal S, Aksoy O, Krishnaswamy A, Griffin BP, Svensson LG, Kapadia SR. Comparison of ascending aortic size in patients with severe bicuspid aortic valve stenosis treated with versus without a statin drug. Am J Cardiol. 2011 Nov 15;108(10):1458-62. doi: 10.1016/j.amjcard.2011.06.071. — View Citation

Jovin IS, Duggal M, Ebisu K, Paek H, Oprea AD, Tranquilli M, Rizzo J, Memet R, Feldman M, Dziura J, Brandt CA, Elefteriades JA. Comparison of the effect on long-term outcomes in patients with thoracic aortic aneurysms of taking versus not taking a statin drug. Am J Cardiol. 2012 Apr 1;109(7):1050-4. doi: 10.1016/j.amjcard.2011.11.038. Epub 2012 Jan 3. — View Citation

McLoughlin D, McGuinness J, Byrne J, Terzo E, Huuskonen V, McAllister H, Black A, Kearney S, Kay E, Hill AD, Dietz HC, Redmond JM. Pravastatin reduces Marfan aortic dilation. Circulation. 2011 Sep 13;124(11 Suppl):S168-73. doi: 10.1161/CIRCULATIONAHA.110.012187. — View Citation

Moura LM, Ramos SF, Zamorano JL, Barros IM, Azevedo LF, Rocha-Gonçalves F, Rajamannan NM. Rosuvastatin affecting aortic valve endothelium to slow the progression of aortic stenosis. J Am Coll Cardiol. 2007 Feb 6;49(5):554-61. Epub 2007 Jan 22. — View Citation

Rossebø AB, Pedersen TR, Boman K, Brudi P, Chambers JB, Egstrup K, Gerdts E, Gohlke-Bärwolf C, Holme I, Kesäniemi YA, Malbecq W, Nienaber CA, Ray S, Skjaerpe T, Wachtell K, Willenheimer R; SEAS Investigators. Intensive lipid lowering with simvastatin and ezetimibe in aortic stenosis. N Engl J Med. 2008 Sep 25;359(13):1343-56. doi: 10.1056/NEJMoa0804602. Epub 2008 Sep 2. — View Citation

Schouten O, van Laanen JH, Boersma E, Vidakovic R, Feringa HH, Dunkelgrün M, Bax JJ, Koning J, van Urk H, Poldermans D. Statins are associated with a reduced infrarenal abdominal aortic aneurysm growth. Eur J Vasc Endovasc Surg. 2006 Jul;32(1):21-6. Epub 2006 Mar 6. — View Citation

Stein LH, Berger J, Tranquilli M, Elefteraides JA. Effect of statin drugs on thoracic aortic aneurysms. Am J Cardiol. 2013 Oct 15;112(8):1240-5. doi: 10.1016/j.amjcard.2013.05.081. — View Citation

Sukhija R, Aronow WS, Sandhu R, Kakar P, Babu S. Mortality and size of abdominal aortic aneurysm at long-term follow-up of patients not treated surgically and treated with and without statins. Am J Cardiol. 2006 Jan 15;97(2):279-80. Epub 2005 Nov 21. — View Citation

* Note: There are 13 references in allClick here to view all references

Outcome

Type Measure Description Time frame Safety issue
Primary Change of the diameter of ascending aorta by CT (Computed Tomography). Determination of the progression of ascending aortic dilation assessed by measuring the change of the diameter of ascending aorta by CT (Computed Tomography).The change of the aortic diameter will be defined by the major difference between the measurements taken in the aortic root and ascending aorta in the initial and final study. 3 years
Secondary Change of the final maximum diameter of the aortic root and the basal measured by CT. Difference between the final maximum diameter of the aortic root and the basal measured by CT. 3 years
Secondary Change of the final maximum diameter of the tubular ascending aorta and the basal measured by CT. Difference between the final maximum diameter of the tubular ascending aorta and the basal measured by CT. 3 years
Secondary Change of the final area of the aortic root and the basal measured by CT. Difference between the final area of the aortic root and the basal measured by CT. 3 years
Secondary Change of the the final area of ascending aorta and the basal measured by CT. Difference between the final area of ascending aorta and the basal measured by CT. 3 years
Secondary Change of the valve Agatston final score and the basal assessed by CT. Difference between the valve Agatston final score and the basal assessed by CT. 3 years
Secondary Change of the final planimetry area of the aortic valve and the basal measured by CT. Difference between the final planimetry area of the aortic valve and the basal measured by CT. 3 years
Secondary Change of the transvalvular pressure gradient of the aortic valve Difference of transvalvular pressure gradient of the aortic valve 3 years
Secondary Change of aortic regurgitation jet width basal and final. Difference of aortic regurgitation jet width basal and final. 3 years
Secondary Change of the maximum aortic velocity Change of the maximum aortic velocity 3 years
Secondary Change of aortic valve area Change of aortic valve area by continuity equation basal and final 3 years
Secondary Ocurrence of Serious Adverse Clinical Events leading to hospitalization and death Serious Adverse Clinical Events: Aortic dissection, aortic rupture or need for aortic surgery, cardiovascular death, death of any cause. Combined endpoint of death, aortic dissection or need for aortic or valve surgery. 3 years
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