Fish Oil and Aspirin With Type 2 Diabetes

NCT ID: NCT01181882

Last Updated: 2013-10-08

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: PHASE2
• Total Enrollment: 30 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2010-08-31
• Study Completion Date: 2012-11-30

Brief Summary

The purpose of this study is to understand if omega-3 fatty acids in fish oil enhance the ability of aspirin to reduce the risk of cardiovascular diseases such as heart attack and stroke in those who have diabetes mellitus.

Detailed Description

A recent increase in the incidence and prevalence of obesity-related diabetes mellitus and the metabolic syndrome as a result of insulin resistance threatens to reverse the health gains achieved in the US during the last half of the 20th century. Novel inexpensive and safe pharmacologic approaches are required to prevent a variety of resulting cardiovascular disease sequelae. Aspirin is a proven agent in the treatment and prevention of cardiovascular disease but is greatly underused. Even when it is used, aspirin is ineffective in a large proportion of the population: a problem termed "aspirin resistance." Approximately thirty percent of the adult US population is aspirin resistant and this proportion is higher in those with diabetes and the metabolic events and affected patients do not benefit from other antiplatelet drugs. The omega-3 fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) are naturally occurring and can be safely used at low cost in individuals who are in high and lower cardiovascular risk groups. Supplementation with EPA and and DHA (EPA + DHA) modifies the fatty acid balance which is distributed in patients with insulin resistance and atherosclerosis, thereby potentially improving endothelial function, lowering blood pressure, and reducing the risk of fatal and non-fatal acute coronary syndromes. Emerging evidence indicates that the combination of aspirin together with EPA+DHA supplementation beneficially regulates fatty acid metabolism and attenuates atherosclerosis. However, the effects of aspirin together with EPA + DHA on aspirin resistance or in subjects with diabetes mellitus and insulin resistance are unknown. Circulating EPA and DHA are contained largely in lysophospholipids, which contain a three carbon backbone and variable fatty acyl side chains. In preliminary data, we show that both aspirin ingestion and EPA+DHA supplementation after lysophospholipids including lysophosphatidylcholine (LPC) and lysophosphatidic acid (LPA) are now known to bind specific G-protein coupled receptors, which are being explored as novel therapeutic targets in cardiovascular and other diseases. Relationships between LPC and LPA metabolism, aspirin ingestion, and human atherosclerosis have not been investigated (to our knowledge). In the proposed study, we will investigate the effects of combining aspirin with EPA+DHA supplementation on platelet function and lysophospholipid metabolism in a clinical trial of individuals with type 2 diabetes mellitus. This trial will build on existing infrastructure in clinical and translational research, as well as our preliminary data using novel in-house assays.

Conditions

Cardiovascular Disease

Keywords

Cardiovascular Disease; Aspirin Resistance; Diabetes Mellitus, Type 2; Platelet Function; Omega-3 Fatty Acids; Aspirin; Lysophospholipids; Lysophosphatidic Acid; Lysophosphatidylcholine

Study Design

• Allocation Method: NON_RANDOMIZED
• Intervention Model: SINGLE_GROUP
• Blinding Strategy: NONE

Study Groups

Fish Oil and Aspirin

Group Type: EXPERIMENTAL

Fish Oil and Aspirin

Intervention Type: DIETARY_SUPPLEMENT

4 grams of fish oil each day for 28 days and 81 mg aspirin

Interventions

Fish Oil and Aspirin

4 grams of fish oil each day for 28 days and 81 mg aspirin

Intervention Type: DIETARY_SUPPLEMENT

Other Intervention Names

Omega-3 EPA/DHA Concentrate; Aspirin

Eligibility Criteria

Inclusion Criteria

• Between the ages of 40-80
• No significant abnormality noted from the CBC, CMP, TSH
• Have diabetes mellitus based on the criteria from the Report of the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. (57) These data will be collected from medical records in conjunction with the Greater Rochester Practice-Based Research Network (see recruitment plan below)

1. Symptoms of diabetes plus casual plasma glucose concentration greater than or equal to 200 mg/dl (11.1 mmol/l). Casual is defined as any time of day without regard to last time since last meal. The classic symptoms of diabetes include polyuria, polydipsia, and unexplained weight loss, or;

2. Fasting plasma glucose greater than or equal to 126 mg/dl (11.1 mmol/l). Fasting is defined as no caloric intake for at least 8 h, or;

3. 2-hour plasma glucose greater than or equal to 200 mg/dl (11.1 mmol/l) during an oral glucose tolerance test. The test should be performed as described by the World Health organization, using a glucose load containing the equivalent of 75 g anhydrous glucose dissolved in water. This is the protocol within the University of Rochester Clinical Labs.

(In the absence of unequivocal hyperglycemia with acute metabolic decompensation, these criteria should have been confirmed by repeat testing on a different day)

• Available for two morning visits (5 hours at bedrest) approximately 28 days apart and 2 short visits for blood draws
• No fish oil, flax seed oil, vitamins, nutri. supplements or herbal preps. during study
• Able to commit to no aspirin, NSAIDS for 10 days prior to each 5-hour study visit
• Able to commit to no more then 2 meals of fish 7 days prior to each visit
• Non-smoker
• Not currently pregnant, and will not become pregnant during study

Exclusion Criteria

• History of drug or alcohol abuse, or current weekly alcohol consumption >14 units/week (1 unit=1 beer, 1 glass of wine, 1 mixed cocktail containing 1 ounce of alcohol)
• Diagnosis of cardiovascular disease including coronary heart disease, congestive heart failure, peripheral vascular disease, stroke, atrial fibrillation, and gastric bypass surgery or malabsorption syndrome.
• History of malignancy (unless disease free for >10 years, or non-melanoma skin carcinoma)
• History of peptic ulcer or gastrointestinal bleeding in past 5 years
• Diagnosed bleeding disorder
• Use of antiplatelet or antithrombotic therapy, defined as clopidogrel, ticlopidine, cilostazol, dipyridamol, trapidil, warfarin, and argatroban

• Minimum Eligible Age: 40 Years
• Maximum Eligible Age: 80 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Cornell University

OTHER

Sponsor Role: collaborator

Albany College of Pharmacy and Health Sciences

OTHER

Sponsor Role: collaborator

University of Rochester

OTHER

Sponsor Role: lead

Responsible Party

Robert Block

Assistant Professor

Responsibility Role: PRINCIPAL_INVESTIGATOR

Principal Investigators

Robert C Block, MD, MPH

Role: PRINCIPAL_INVESTIGATOR

University of Rochester

Locations

Clinical Research Center of the University of Rochester Medical Center

Rochester, New York, United States

Countries

United States

References

Block RC, Abdolahi A, Tu X, Georas SN, Brenna JT, Phipps RP, Lawrence P, Mousa SA. The effects of aspirin on platelet function and lysophosphatidic acids depend on plasma concentrations of EPA and DHA. Prostaglandins Leukot Essent Fatty Acids. 2015 May;96:17-24. doi: 10.1016/j.plefa.2014.12.005. Epub 2014 Dec 22.

Reference Type: DERIVED

PMID: 25555354 (View on PubMed)

Abdolahi A, Georas SN, Brenna JT, Cai X, Thevenet-Morrison K, Phipps RP, Lawrence P, Mousa SA, Block RC. The effects of aspirin and fish oil consumption on lysophosphatidylcholines and lysophosphatidic acids and their correlates with platelet aggregation in adults with diabetes mellitus. Prostaglandins Leukot Essent Fatty Acids. 2014 Feb-Mar;90(2-3):61-8. doi: 10.1016/j.plefa.2013.12.004. Epub 2013 Dec 18.

Reference Type: DERIVED

PMID: 24373610 (View on PubMed)

Block RC, Abdolahi A, Smith B, Meednu N, Thevenet-Morrison K, Cai X, Cui H, Mousa S, Brenna JT, Georas S. Effects of low-dose aspirin and fish oil on platelet function and NF-kappaB in adults with diabetes mellitus. Prostaglandins Leukot Essent Fatty Acids. 2013 Jul;89(1):9-18. doi: 10.1016/j.plefa.2013.03.005. Epub 2013 May 7.

Reference Type: DERIVED

PMID: 23664596 (View on PubMed)

Other Identifiers

RSRB00030668

Identifier Type: -

Identifier Source: org_study_id