Evaluation of Non-invasive Measurements of Atherosclerosis in Cardiovascular Risk Stratification

NCT ID: NCT01555294

Last Updated: 2012-03-15

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Total Enrollment

1960 participants

Study Classification

OBSERVATIONAL

Study Start Date

2005-05-31

Study Completion Date

2011-05-31

Brief Summary

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Multiple risk factors contribute to atherosclerosis, which ultimately results in clinical manifestation of cardiovascular disease. Atherosclerosis results in both functional and morphological changes in the vessel wall, which can be measured by ultrasonography. The current study has been designed to

1. To evaluate whether non-invasive measurements of atherosclerosis are independent predictors of cardiovascular disease and
2. to delineate new biochemical parameters and genetic variations, allowing earlier and more effective preventive therapy
3. The investigators intend to set guidelines for use of NIMA in an outpatient setting to facilitate early detection of increased cardiovascular risk and monitor life-style and pharmaceutical interventions.

In both the general population and in Familial Combined Hyperlipidemia.

Detailed Description

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Cardiovascular disease (CVD) is the major cause of death in all developed countries. Atherosclerosis is the main cause of CVD. Abundant evidence indicates the 4 major independent risk factors for atherosclerosis and CVD include cigarette smoking, elevated blood pressure, elevated total cholesterol and diabetes mellitus. However, a major problem in clinical medicine is that at every level of risk factor exposure, there is a large inter-individual variation in the amount of atherosclerosis and the development of CVD. Therefore, it is difficult to predict the CVD risk in an individual patient based on risk factor screening alone.

Non-invasive measurements of atherosclerosis (NIMA): An indicator of the overall effect of all known and unknown potential risk factors for atherosclerosis in vivo can be assessed by measuring atherosclerosis directly in the vessel wall. This also provides the opportunity to measure atherosclerosis before developing symptoms of CVD, as changes in the arterial wall precede clinical symptoms of CVD.

Objectives: (1)The main objective is to evaluate whether NIMA are independent predictors of CVD and thus add information to traditional risk factor stratification. (2) Furthermore, we will delineate new biochemical and genetic risk factors, allowing earlier and more effective preventive therapy. (3) We intend to set guidelines for use of NIMA in an outpatient setting to facilitate early detection of increased cardiovascular risk and monitor life-style and pharmaceutical interventions.

We will evaluate 4 different NIMA, based on ultrasound and tonometry techniques, including intima media thickness (IMT), endothelial function by flow mediated dilation (FMD), ankle-brachial index (ABI), Pulse Wave Analyses(PWA) and pulse wave velocity (PWV). The power of NIMA, to predict cardiovascular events will be studied in two available populations, a low risk population cohort, the Nijmegen Biomedical Study (NBS) and a high risk population, families with Familial Combined Hyperlipidemia.

The NBS is a prospective population survey aimed at investigating the frequency of genetic variations in the general population. The study population is recruited as a sex- and age-stratified random sample of all inhabitants of Nijmegen 20 to 90 years old (n=10.000). Recruitment has started in October 2001. The present study is a substudy in the NBS. A follow-up approach will be used to evaluate whether NIMA are related to future cardiovascular events. In total 1517 participants aged 50-70 years were included.

FCH is the most common inherited hyperlipidemia in man. Affected individuals are characterized by elevated cholesterol and/or triglyceride levels and other associated traits including small-dense LDL, insulin resistance, oxidative stress and increased apoB levels, which have been proposed to contribute to the increased risk of CVD. So, this population will be most informative to evaluate the relevance of NIMA in CVD risk assessment as patients exhibit numerous, additive risk factors, which are missed in traditional cardiovascular risk assessment. Our data base contains a unique population of 40 well-characterized FCH families, including 687 patients, relatives and spouses with 5 years follow-up data. These families participate in an ongoing long-term follow-up program with registration of CVD.

All four NIMA's, including IMT, ABI, PWV/PWA, FMD, and both traditional and new biochemical and genetic parameters will be measured in both populations. The relevance of NIMA in identifying subjects at increased risk of CVD will be determined. Furthermore, the effect of risk factors on IMT, ABI, PWV and FMD will be studied, including clinical and traditional risk factors and new biochemical parameters and genetic variations.

Innovative aspects: We will develop an evidence based protocol for NIMA to show the presence of atherosclerosis before clinical manifestation of CVD and to improve cardiovascular risk stratification beyond traditional risk factor screening. Furthermore, we will delineate new risk factors, including both biochemical parameters and genetic variations, contributing to design optimal (new) treatment and to develop new strategies for prevention of CVD in the general population and in a high risk population, FCH.

Clinical relevance: If NIMA turns out to provide powerful information in identifying subjects at increased risk of CVD we will incorporate NIMA into clinical practice guidelines for the purpose of cardiovascular risk stratification and evaluation of risk management strategies. The identification of potential new biochemical and/or genetic risk factors will be very helpful to design optimal treatment and to develop new strategies for identification and prevention of CVD in both the general population and families with FCH.

Conditions

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Cardiovascular Disease

Study Design

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Study Time Perspective

PROSPECTIVE

Study Groups

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community-based cohort

The present study is a substudy in the Nijmegen Biomedical Study (NBS). The NBS is a prospective population survey aimed at investigating the frequency of genetic variations in the general population. The study population is recruited as a sex- and age-stratified random sample of all inhabitants of Nijmegen 20 to 90 years old (n=10.000). Recruitment has started in october 2001.

In the current study 1517 participants aged 50-70 years were included from 2005 to 2008, from whom baseline characteristics were obtained. All visited our hospital and during the visit venous blood was drawn, height and weight were measured, a questionnaire about medical history, life style habits, and family history was completed and non-invasive measurements of atherosclerosis were performed.

No interventions assigned to this group

Familial Combined Hyperlipidemia

FCH is the most common inherited dyslipidemia in man. Affected individuals are characterized by elevated cholesterol and/or triglyceride levels and an increased risk of CVD. Our data base contains a unique population of 40 well-characterized FCH families, including 687 patients, relatives and spouses. These families were recruited in 1994 and extensively studied, including information on an extensive panel of biochemical and genetic parameters. In total 343 participants were included in the NIMA study; 103 FCH patients and 240 unaffected relatives from whom baseline characteristics were obtained.

No interventions assigned to this group

Eligibility Criteria

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Inclusion Criteria

* aged 50-70 years at inclusion


* age \>18 years

Exclusion Criteria

* recent symptomatic CV disease (\<6 months)

Familial Combined Hyperlipidemia:


* pregnancy
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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Radboud University Medical Center

OTHER

Sponsor Role lead

Responsible Party

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Jacqueline de Graaf

Prof. Dr. J. de Graaf

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Jacqueline de Graaf, MD, PhD

Role: PRINCIPAL_INVESTIGATOR

Radboud University Nijmegen Medical Centre, Dept. of General Internal Medicine, Division of Vascular Medicine

Anton FH Stalenhoef, MD, PhD

Role: STUDY_CHAIR

Radboud University Nijmegen Medical Centre, Dept. of General Internal Medicine, Division of Vascular Medicine

Martin den Heijer, MD, PhD

Role: STUDY_CHAIR

Radboud University Nijmegen Medical Centre, Dept. of Epidemiology and Biostatistics

Suzanne Holewijn, PhD

Role: STUDY_CHAIR

Radboud University Nijmegen Medical Centre, Dept. of General Internal Medicine, Division of Vascular Medicine

Locations

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Radboud University Nijmegen Medical Centre, Department of General Internal Medicine, Division of Vascular Medicine

Nijmegen, , Netherlands

Site Status

Countries

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Netherlands

References

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Reference Type BACKGROUND
PMID: 20622881 (View on PubMed)

ter Avest E, Holewijn S, Stalenhoef AF, de Graaf J. Variation in non-invasive measurements of vascular function in healthy volunteers during daytime. Clin Sci (Lond). 2005 May;108(5):425-31. doi: 10.1042/CS20040300.

Reference Type RESULT
PMID: 15636580 (View on PubMed)

ter Avest E, Abbink EJ, Holewijn S, de Graaf J, Tack CJ, Stalenhoef AF. Effects of rosuvastatin on endothelial function in patients with familial combined hyperlipidaemia (FCH). Curr Med Res Opin. 2005 Sep;21(9):1469-76. doi: 10.1185/030079905X61910.

Reference Type RESULT
PMID: 16197666 (View on PubMed)

ter Avest E, Holewijn S, Bredie SJ, Stalenhoef AF, de Graaf J. Remnant particles are the major determinant of an increased intima media thickness in patients with familial combined hyperlipidemia (FCH). Atherosclerosis. 2007 Mar;191(1):220-6. doi: 10.1016/j.atherosclerosis.2006.03.025. Epub 2006 May 4.

Reference Type RESULT
PMID: 16677651 (View on PubMed)

ter Avest E, Holewijn S, Bredie SJ, van Tits LJ, Stalenhoef AF, de Graaf J. Pulse wave velocity in familial combined hyperlipidemia. Am J Hypertens. 2007 Mar;20(3):263-9. doi: 10.1016/j.amjhyper.2006.09.015.

Reference Type RESULT
PMID: 17324737 (View on PubMed)

Ter Avest E, Holewijn S, van Tits LJ, de Wit HM, Stalenhoef AF, de Graaf J. Endothelial function in familial combined hyperlipidaemia. Eur J Clin Invest. 2007 May;37(5):381-9. doi: 10.1111/j.1365-2362.2007.01804.x.

Reference Type RESULT
PMID: 17461984 (View on PubMed)

Koenen TB, van Tits LJ, Holewijn S, Lemmers HL, den Heijer M, Stalenhoef AF, de Graaf J. Adiponectin multimer distribution in patients with familial combined hyperlipidemia. Biochem Biophys Res Commun. 2008 Nov 7;376(1):164-8. doi: 10.1016/j.bbrc.2008.08.111. Epub 2008 Aug 30.

Reference Type RESULT
PMID: 18762168 (View on PubMed)

Holewijn S, den Heijer M, Swinkels DW, Stalenhoef AF, de Graaf J. The metabolic syndrome and its traits as risk factors for subclinical atherosclerosis. J Clin Endocrinol Metab. 2009 Aug;94(8):2893-9. doi: 10.1210/jc.2009-0084. Epub 2009 May 5.

Reference Type RESULT
PMID: 19417041 (View on PubMed)

Holewijn S, den Heijer M, Swinkels DW, Stalenhoef AF, de Graaf J. Brachial artery diameter is related to cardiovascular risk factors and intima-media thickness. Eur J Clin Invest. 2009 Jul;39(7):554-60. doi: 10.1111/j.1365-2362.2009.02152.x. Epub 2009 May 8.

Reference Type RESULT
PMID: 19453648 (View on PubMed)

Holewijn S, den Heijer M, van Tits LJ, Swinkels DW, Stalenhoef AF, de Graaf J. Impact of waist circumference versus adiponectin level on subclinical atherosclerosis: a cross-sectional analysis in a sample from the general population. J Intern Med. 2010 Jun;267(6):588-98. doi: 10.1111/j.1365-2796.2009.02192.x. Epub 2009 Nov 4.

Reference Type RESULT
PMID: 20210840 (View on PubMed)

Holewijn S, den Heijer M, Swinkels DW, Stalenhoef AF, de Graaf J. Apolipoprotein B, non-HDL cholesterol and LDL cholesterol for identifying individuals at increased cardiovascular risk. J Intern Med. 2010 Dec;268(6):567-77. doi: 10.1111/j.1365-2796.2010.02277.x.

Reference Type RESULT
PMID: 21091808 (View on PubMed)

Holewijn S, Sniderman AD, den Heijer M, Swinkels DW, Stalenhoef AF, de Graaf J. Application and validation of a diagnostic algorithm for the atherogenic apoB dyslipoproteinemias: ApoB dyslipoproteinemias in a Dutch population-based study. Eur J Clin Invest. 2011 Apr;41(4):423-33. doi: 10.1111/j.1365-2362.2010.02426.x. Epub 2010 Dec 3.

Reference Type RESULT
PMID: 21128932 (View on PubMed)

Bus BA, Marijnissen RM, Holewijn S, Franke B, Purandare N, de Graaf J, den Heijer M, Buitelaar JK, Voshaar RC. Depressive symptom clusters are differentially associated with atherosclerotic disease. Psychol Med. 2011 Jul;41(7):1419-28. doi: 10.1017/S0033291710002151. Epub 2010 Dec 10.

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Holewijn S, den Heijer M, Stalenhoef AF, de Graaf J. Non-invasive measurements of atherosclerosis (NIMA): current evidence and future perspectives. Neth J Med. 2010 Dec;68(12):388-99.

Reference Type RESULT
PMID: 21209464 (View on PubMed)

Marijnissen RM, Bus BA, Holewijn S, Franke B, Purandare N, de Graaf J, den Heijer M, Buitelaar JK, Oude Voshaar RC. Depressive symptom clusters are differentially associated with general and visceral obesity. J Am Geriatr Soc. 2011 Jan;59(1):67-72. doi: 10.1111/j.1532-5415.2010.03228.x.

Reference Type RESULT
PMID: 21226677 (View on PubMed)

Ter Avest E, Stalenhoef AF, de Graaf J. What is the role of non-invasive measurements of atherosclerosis in individual cardiovascular risk prediction? Clin Sci (Lond). 2007 May;112(10):507-16.

Reference Type RESULT
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de Graaf J, van der Vleuten GM, ter Avest E, Dallinga-Thie GM, Stalenhoef AF. High plasma level of remnant-like particles cholesterol in familial combined hyperlipidemia. J Clin Endocrinol Metab. 2007 Apr;92(4):1269-75. doi: 10.1210/jc.2006-1973. Epub 2007 Jan 16.

Reference Type RESULT
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van der Vleuten GM, Isaacs A, Zeng WW, ter Avest E, Talmud PJ, Dallinga-Thie GM, van Duijn CM, Stalenhoef AF, de Graaf J. Haplotype analyses of the APOA5 gene in patients with familial combined hyperlipidemia. Biochim Biophys Acta. 2007 Jan;1772(1):81-8. doi: 10.1016/j.bbadis.2006.10.012. Epub 2006 Oct 26.

Reference Type RESULT
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ter Avest E, Abbink EJ, de Graaf J, Tack CJ, Stalenhoef AF. Effect of rosuvastatin on insulin sensitivity in patients with familial combined hyperlipidaemia. Eur J Clin Invest. 2005 Sep;35(9):558-64. doi: 10.1111/j.1365-2362.2005.01549.x.

Reference Type RESULT
PMID: 16128862 (View on PubMed)

Brouwers MC, de Graaf J, van Greevenbroek MM, Georgieva AM, van der Kallen CJ, Ter Avest E, Stehouwer CD, Stalenhoef AF, de Bruin TW. Parabolic relationship between plasma triacylglycerols and LDL-cholesterol in familial combined hyperlipidaemia: the multiple-type hyperlipidaemia explained? Clin Sci (Lond). 2008 Mar;114(5):393-401. doi: 10.1042/CS20070314.

Reference Type RESULT
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van Himbergen TM, van Tits LJ, Ter Avest E, Roest M, Voorbij HA, de Graaf J, Stalenhoef AF. Paraoxonase (PON1) is associated with familial combined hyperlipidemia. Atherosclerosis. 2008 Jul;199(1):87-94. doi: 10.1016/j.atherosclerosis.2007.10.017. Epub 2007 Dec 21.

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Reference Type RESULT
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Other Identifiers

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CMO 2003/174

Identifier Type: -

Identifier Source: org_study_id

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