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Stop Atherosclerosis in Native Diabetics Study (SANDS)

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details.
ClinicalTrials.gov Identifier: NCT00147251
Recruitment Status : Completed
First Posted : September 7, 2005
Results First Posted : July 7, 2021
Last Update Posted : July 7, 2021
Information provided by (Responsible Party):
Cynthia West, Medstar Health Research Institute

Brief Summary:
Compared to standard treatment goals achieving lower targets for LDL cholesterol (bad cholesterol) and blood pressure in people with diabetes will slow the progression of atherosclerosis as measured by carotid artery thickness, and reduce clinical cardiovascular events such as heart attacks and strokes. This study is a randomized 3-year trial. The primary endpoint will be a combination of various measures of the carotid artery, (which is an easy, non-invasive way to detect cardiovascular disease) and events such as heart attacks and strokes. The study will also look at secondary endpoints such as how well the heart pumps, fat,protein and inflammatory markers in the blood,and kidney function. The study enrolled 549 American Indian men and women with diabetes, > 40 years of age and is being conducted in four field centers involving Indian Health Service/Tribal primary care facilities in Phoenix/Sacaton, Arizona; Chinle, Arizona; Rapid City/Pine Ridge, South Dakota; and Lawton, Oklahoma, with input from American Indian physicians and community members.

Condition or disease Intervention/treatment Phase
Cardiovascular Disease Hypertension Hyperlipidemia Diabetes Carotid Atherosclerosis Drug: FDA approved drugs to treat blood pressure and cholesterol Phase 4

Detailed Description:
Diabetes incidence is increasing rapidly in the United States. Diabetes increases the risk for CVD, the major cause of death in diabetic individuals. The conventional cardiovascular risk factors of hyperlipidemia and hypertension add to the progression of diabetic vascular disease. Appropriate treatment targets for LDL-C and blood pressure in diabetic individuals are currently being debated. The Stop Atherosclerosis in Native Diabetics Study is a randomized, open label, 3-year, clinical trial to examine the effects of aggressive LDL-C (goal < 70 mg/dL) and BP (goal < 115/75 mm Hg) reduction versus the standard goals of < 100 mg/dL for LDL-C and < 130/85 mmHg for BP. Five hundred forty-nine American Indian men and women > age 40 with type 2 diabetes were randomized to one of two groups. Lipids and BP are managed using FDA-approved medications in an algorithmic approach. The presence and progression of atherosclerosis are evaluated by carotid ultrasonography; echocardiography assesses cardiac function. The primary endpoint is the composite outcome of change in carotid artery intimal medial thickness and fatal/nonfatal cardiovascular events. These outcomes are combined by using a ranked analysis for carotid thickness and assigning a "worst rank" for a cardiovascular event. Secondary endpoints include carotid plaque score, left ventricular geometry and function, serum CRP, and safety measures. Unique aspects of the study design and analysis plan involve changes during the trial of LDL-C treatment goals for participants with baseline or incident CVD in the conventional group, because of changes in the standard of care, and the use of a composite outcome. Study results will be valuable in understanding the effects of aggressive risk factor reduction on atherosclerosis burden and cardiac function in diabetic individuals in all U.S. populations and will provide evidence for determining optimal LDL-C and BP treatment goals for diabetic patients.

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 548 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Prevention
Official Title: Stop Atherosclerosis in Native Diabetics Study
Study Start Date : May 2003
Actual Primary Completion Date : November 2006
Actual Study Completion Date : May 1, 2007

Arm Intervention/treatment
No Intervention: SANDS Control Group
Standard Treatment for blood pressure and cholesterol
Active Comparator: SANDS Intervention Group
FDA approved drugs to treat blood pressure and cholesterol
Drug: FDA approved drugs to treat blood pressure and cholesterol
Other Name: No Intervention

Primary Outcome Measures :
  1. Changing LDL Cholesterol [ Time Frame: 36 months ]

    LDL cholesterol intervention to lower targets than are currently recommended to retard atherosclerosis measured by LDL-C mg/dL.

    Scale: LDL cholesterol levels should be less than 100 mg/dL

Secondary Outcome Measures :
  1. Changing Blood Pressure [ Time Frame: 36 month follow-up ]

    Treatment of blood pressure to prevent/reduce diseases of heart and blood vessels. Measured by mmHG.

    Normal values should be below 120/80 mm Hg.

Information from the National Library of Medicine

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Ages Eligible for Study:   40 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   Yes

Inclusion Criteria:

  1. American Indian men and women 40 years of age or older
  2. Type 2 DM (according to 1997 ADA criteria and/or previously diagnosed by former ADA or WHO criteria): fasting plasma glucose >= 7.0 mmol/L (126 mg/dL) or 2-hour glucose >= 11.0 mmol/L (>200 mg/dL) after a 75-gram oral glucose tolerance test.
  3. LDL cholesterol >= 100 mg/dL. within the previous 12 months.
  4. Systolic BP >= 130 mm Hg. within the previous 12 months.

Exclusion Criteria:

  1. New York Heart Association Stage III- IV congestive heart failure.
  2. SBP >180 mmHg (2% of population) or patients with known causes of hypertension.
  3. History of angioedema.
  4. Any medical condition that study physicians believe would interfere with study participation or evaluation of results.
  5. Mental incapacity and/or cognitive impairment on the part of the patient that would preclude adequate understanding of, or cooperation with, the study protocol.
  6. Serum hepatic transaminase levels 2X the upper limit of normal.
  7. Participation in any clinical trial of any investigational medication within 3 months prior to this trial.
  8. Renal insufficiency as indicated by serum creatinine >2.0 for women and >2.4 for men.
  9. Diagnosis of primary hyperlipidemia in medical record.
  10. Secondary hypercholesterolemia due to hypothyroidism or nephrotic syndrome. Patients on stable doses of thyroid replacement therapy will be eligible.
  11. Presence of malignancy or history of any cancer except skin cancer within the past 5 years.
  12. Pregnancy or lactation. Premenopausal women will be requested to use birth control methods throughout the study and provided educational materials about the risks of using the study medications during pregnancy.
  13. Unable to obtain quantifiable carotid measure during screening examination.
  14. Concomitant long term use of cyclosporins (Sandimmune), macrolide antibiotics (erythromycin -many generic and brand name forms, clarithromycin, Biaxin, and Zithromax), azole antifungals (itraconazole-Sporanox, ritonavir, Norvir, and nelfinavir (Viracept).
  15. Orthostatic hypotension as defined by the following:

    1. The individual has a measured fall of >20 mmHg in systolic BP upon standing associated with symptoms lasting more than one minute (or severe symptoms that would not allow further lowering of BP)
    2. The standing systolic blood pressure is less than 90 mm.
  16. Triglyceride level >350 mg/dl.
  17. Severe aortic stenosis with valve area <=1.0 square cm.

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT00147251

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United States, Arizona
Chinle Comprehensive Health Care
Chinle, Arizona, United States, 86503
Phoenix Indian Medical Center
Phoenix, Arizona, United States, 85016
United States, Oklahoma
USPHS Indian Hospital
Lawton, Oklahoma, United States, 73507
United States, South Dakota
Black Hills Center for American Indian Health
Rapid City, South Dakota, United States, 57701
Sponsors and Collaborators
Cynthia West
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Principal Investigator: Barbara V Howard, PhD Medstar Health Research Institute
Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
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Responsible Party: Cynthia West, Phoenix Field Office Manager, Medstar Health Research Institute
ClinicalTrials.gov Identifier: NCT00147251    
Obsolete Identifiers: NCT00047424
Other Study ID Numbers: 2000-285
Grant # 1 U01 HL67031 ( Other Grant/Funding Number: NHLBI )
First Posted: September 7, 2005    Key Record Dates
Results First Posted: July 7, 2021
Last Update Posted: July 7, 2021
Last Verified: June 2021
Keywords provided by Cynthia West, Medstar Health Research Institute:
lowering LDL and BP below current targets
LDL cholesterol treatment
blood pressure treatment
carotid intimal medial thickness
prevent progression of CVD
Additional relevant MeSH terms:
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Carotid Artery Diseases
Cardiovascular Diseases
Vascular Diseases
Arterial Occlusive Diseases
Lipid Metabolism Disorders
Metabolic Diseases
Cerebrovascular Disorders
Brain Diseases
Central Nervous System Diseases
Nervous System Diseases