Lifestyle Modification Programme for Patients With Asymptomatic Carotid Artery Stenosis

NCT ID: NCT03929354

Last Updated: 2021-08-04

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

UNKNOWN

Clinical Phase

NA

Total Enrollment

208 participants

Study Classification

INTERVENTIONAL

Study Start Date

2018-06-01

Study Completion Date

2022-09-01

Brief Summary

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This study randomises patients with patients with asymptomatic carotid artery stenosis, to be managed either by providing an intensive 12-week lifestyle modification programme, or standard healthcare.

Detailed Description

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Cardiovascular disease (CVD) is the leading cause of mortality and acquired disability globally. According to the World Health Organisation (WHO), 30% of total global deaths are due to CVD, and approximately 6 million deaths result from cerebrovascular disease.

A common cause of cerebrovascular disease is internal carotid artery stenosis. Despite recent advances in carotid artery revascularisation, risk factor modification remains the cornerstone of therapy for this devastating disease. According to the European Society of Cardiology (ESC), the lifestyle risk factors for vascular diseases include; cigarette smoking, physical inactivity, increased body mass index, and unhealthy diet, and stress, while the medical risk factors include; High blood pressure, elevated blood sugar, and hyperlipidaemia. All these factors have been identified in several studies as significant modifiable risk factors that should be targeted for preventing morbidity and mortality resulting from cerebrovascular disease.

Previous studies indicated that modifiable risk factor programmes can help cardiac patients to achieve their risk factor modification targets. However, to date there do not seem to be any studies assessing the outcomes of a multidisciplinary risk factor modification programme in patients with carotid artery stenosis. Our study will evaluate the impact of an intensive 12-week, multidisciplinary risk factors modification programme on medical and lifestyle risk factors modification, as well as on risk reduction for stroke and cardiovascular events, among patients with asymptomatic carotid artery stenosis. We will compare these outcomes to that of standard care traditionally provided to this high-risk patient group.

Conditions

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Carotid Stenosis

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

This is a randomised, parallel group, active-control trial, with patients randomised in a 1:1 ratio to one of two treatment arms.
Primary Study Purpose

TREATMENT

Blinding Strategy

DOUBLE

Investigators Outcome Assessors
Blinding of trial participants and care providers is not possible because of obvious differences between the interventions. However, the investigator, the outcomes assessor and statistician are blinded to treatment received.

Study Groups

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Risk Factors Modification Programme

* Patients in the intervention arm will attend the 12-week intensive lifestyle programme which includes healthy lifestyle change such as smoking cessation, healthy food choices and increasing physical activity levels, as well as management of cholesterol, diabetes, and blood pressure.
* The 12-week programme will consist of 12 sessions of 2.5 hours each per week.
* Each of the weekly sessions will incorporate an individualised meeting between the multidisciplinary healthcare team and each patient to review the progress and health goals.
* The weekly sessions will also include a one-hour group exercise programme and an educational workshop.

Group Type EXPERIMENTAL

Risk Factors Modification Programme

Intervention Type BEHAVIORAL

12-week supervised risk factor modification programme derived from the EuroAction Study standards.

Standard Care

Standard care is defined as giving information and advice to the patients to modify their lifestyles but without providing a structured intervention or an individualised plan.

Group Type ACTIVE_COMPARATOR

Standard Care

Intervention Type BEHAVIORAL

Patients advised to adjust lifestyle without the support of the structured supervised programme.

Interventions

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Risk Factors Modification Programme

12-week supervised risk factor modification programme derived from the EuroAction Study standards.

Intervention Type BEHAVIORAL

Standard Care

Patients advised to adjust lifestyle without the support of the structured supervised programme.

Intervention Type BEHAVIORAL

Eligibility Criteria

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Inclusion Criteria

* Adults aged 18 years or more.
* Provide written informed consent.
* History of asymptomatic carotid artery stenosis, defined as a stenosis of the internal carotid artery of 50% or higher, but without history of any cerebrovascular events within the previous 6 months.
* Patients should have at least one of the following risk factors:

1. Blood pressure \> 140/80 mmHg
2. Fasting blood sugar \> 53 mmol/mol (HbA1c \> 7%)
3. Total cholesterol \> 5 mmol/l
4. Low-density lipoprotein (LDL) cholesterol \> 2.6 mmol/l
5. Triglycerides \> 1.7 mmol/l
6. High-density lipoprotein (HDL) cholesterol ˂ 1.2 mmol/l in females, and ˂ 1 mmol/l in males.
7. Body mass index (BMI) \> 25 kg/m\^2.
8. Waist circumference of \> 80 cm in women, and \> 94 cm in men.
9. Mediterranean diet score \< 12
10. Physically inactive.
11. Current smoker or exposure to tobacco in any form.

Exclusion Criteria

* Patients with symptomatic carotid stenosis and with a documented symptomatic cerebrovascular event. A cerebrovascular event is considered if the patient experienced any of an amaurosis fugax, transient ischaemic attack (TIA), or stroke within the past 6 months.
* Significant cognitive impairment or mental illness.
* Currently pregnant women (confirmed by β-Human chorionic gonadotropin (HCG) analysis).
* Inadequate English language ability to understand the content of the intervention programme.
* Involvement in another clinical trial in the previous six months.
* Legal incapacity.
* Patient is bed-ridden or immobile.
* Contraindication to antiplatelet or anticoagulation therapy, or any of risk factor medications.
* Presence of any illness that could limit long-term compliance.
Minimum Eligible Age

18 Years

Maximum Eligible Age

100 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Western Vascular Institute, Ireland

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Wael Tawfick, MB BcH,MRCSI

Role: PRINCIPAL_INVESTIGATOR

Western Vascular Institute, Ireland

Sherif Sultan, MD, FRCSI

Role: PRINCIPAL_INVESTIGATOR

Western Vascular Institute, Ireland

Abdelsalam BenSaaud, MB BcH, MSc

Role: STUDY_DIRECTOR

Western Vascular Institute, Ireland

Locations

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Department of Vascular Surgery, Western Vascular Institute, Galway University Hospital

Galway, , Ireland

Site Status RECRUITING

Countries

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Ireland

Central Contacts

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Wael Tawfick, MB BcH,MRCSI

Role: CONTACT

+ 35391542535

Sherif Sultan, MD, FRCSI

Role: CONTACT

+35391542534

Facility Contacts

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Sherif Sultan, MD

Role: primary

+35391542534

Wael Tawfick, MD

Role: backup

+35391542535

References

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Perk J, De Backer G, Gohlke H, Graham I, Reiner Z, Verschuren WM, Albus C, Benlian P, Boysen G, Cifkova R, Deaton C, Ebrahim S, Fisher M, Germano G, Hobbs R, Hoes A, Karadeniz S, Mezzani A, Prescott E, Ryden L, Scherer M, Syvanne M, Scholte Op Reimer WJ, Vrints C, Wood D, Zamorano JL, Zannad F; Comitato per Linee Guida Pratiche (CPG) dell'ESC. [European Guidelines on Cardiovascular Disease Prevention in Clinical Practice (version 2012). The Fifth Joint Task Force of the European Society of Cardiology and other societies on cardiovascular disease prevention in clinical practice (constituted by representatives of nine societies and by invited experts)]. G Ital Cardiol (Rome). 2013 May;14(5):328-92. doi: 10.1714/1264.13964. No abstract available. Italian.

Reference Type BACKGROUND
PMID: 23612326 (View on PubMed)

Piepoli MF, Hoes AW, Agewall S, Albus C, Brotons C, Catapano AL, Cooney MT, Corra U, Cosyns B, Deaton C, Graham I, Hall MS, Hobbs FDR, Lochen ML, Lollgen H, Marques-Vidal P, Perk J, Prescott E, Redon J, Richter DJ, Sattar N, Smulders Y, Tiberi M, van der Worp HB, van Dis I, Verschuren WMM. [2016 European guidelines on cardiovascular disease prevention in clinical practice. The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts. Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation]. G Ital Cardiol (Rome). 2017 Jul-Aug;18(7):547-612. doi: 10.1714/2729.27821. No abstract available. Italian.

Reference Type BACKGROUND
PMID: 28714997 (View on PubMed)

Kaikkonen JE, Mikkila V, Magnussen CG, Juonala M, Viikari JS, Raitakari OT. Does childhood nutrition influence adult cardiovascular disease risk?--insights from the Young Finns Study. Ann Med. 2013 Mar;45(2):120-8. doi: 10.3109/07853890.2012.671537. Epub 2012 Apr 12.

Reference Type BACKGROUND
PMID: 22494087 (View on PubMed)

de Lorgeril M, Salen P, Martin JL, Monjaud I, Delaye J, Mamelle N. Mediterranean diet, traditional risk factors, and the rate of cardiovascular complications after myocardial infarction: final report of the Lyon Diet Heart Study. Circulation. 1999 Feb 16;99(6):779-85. doi: 10.1161/01.cir.99.6.779.

Reference Type BACKGROUND
PMID: 9989963 (View on PubMed)

Iaccarino Idelson P, Scalfi L, Valerio G. Adherence to the Mediterranean Diet in children and adolescents: A systematic review. Nutr Metab Cardiovasc Dis. 2017 Apr;27(4):283-299. doi: 10.1016/j.numecd.2017.01.002. Epub 2017 Jan 12.

Reference Type BACKGROUND
PMID: 28254269 (View on PubMed)

Yusuf S, Hawken S, Ounpuu S, Dans T, Avezum A, Lanas F, McQueen M, Budaj A, Pais P, Varigos J, Lisheng L; INTERHEART Study Investigators. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet. 2004 Sep 11-17;364(9438):937-52. doi: 10.1016/S0140-6736(04)17018-9.

Reference Type BACKGROUND
PMID: 15364185 (View on PubMed)

Wood DA, Kotseva K, Connolly S, Jennings C, Mead A, Jones J, Holden A, De Bacquer D, Collier T, De Backer G, Faergeman O; EUROACTION Study Group. Nurse-coordinated multidisciplinary, family-based cardiovascular disease prevention programme (EUROACTION) for patients with coronary heart disease and asymptomatic individuals at high risk of cardiovascular disease: a paired, cluster-randomised controlled trial. Lancet. 2008 Jun 14;371(9629):1999-2012. doi: 10.1016/S0140-6736(08)60868-5.

Reference Type BACKGROUND
PMID: 18555911 (View on PubMed)

Other Identifiers

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WVI-CAS

Identifier Type: -

Identifier Source: org_study_id

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