Statin Use in Abdominal Aortic Aneurysm Repair

Study Description

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Brief Summary:

Aneurysm formation is associated with a chronic inflammatory response, depletion of smooth muscle cell population and excessive matrix metalloproteinases (MMPs) production. 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors (statins) are lipid lowering agents with pleiotropic effects including anti-inflammatory activity. Elective open AAA repair patients will be randomised to receive either statin (Atorvastatin 80 mg) or placebo (dummy tablet) for 4 weeks pre-operatively. Tissue samples will be obtained from patient's aneurysm to assess MMP's and their inhibitors TIMP's. It is hypothesized that patients receiving statin will have reduced MMP's.

Condition or disease	Intervention/treatment	Phase
Abdominal Aortic Aneurysm	Drug: Atorvastatin; Other: Placebo	Phase 4

Detailed Description:

All patients listed for elective open AAA repair will be screened for suitability to participate within the study. In this double blind randomized control trial patients will be recruited through vascular surgical outpatient clinics. After inclusion, informed consent and evaluation of base line characteristics patients will be given a prescription for study medication. This prescription was exchanged by the patient for medication at the hospital pharmacy. Randomization will be carried out by pharmacy with computer generated sequence with a sub group size of 4. This will ascertain the order of prescribed drug/ placebo. Pharmacy then dispensed the drug/ placebo in this order. Drug used will be Atorvastatin 80 mg, white, elliptical, film coated tablets debossed '80' on one side and 'PD 158' on the other side. The placebo is similar in shape and colour. Drug/ placebo will be given for 4 weeks pre-operatively. Full thickness infrarenal aortic samples will obtained at time of operation and the exact sample site will be recorded. Samples will be washed with 0.9% saline to remove blood and clots, snap-frozen and stored at -80C for subsequent MMP 2, 8 and 9 and TIMP 1 and 2 analyses.

Study Design

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Study Type :	Interventional (Clinical Trial)
Actual Enrollment :	40 participants
Allocation:	Randomized
Intervention Model:	Parallel Assignment
Masking:	Triple (Participant, Care Provider, Investigator)
Official Title:	Randomised Controlled Trial of Effect of Pre-operative Statin Use on Matrix Metalloproteinases (MMP) & Tissue Inhibitors of Matrix Metalloproteinases (TIMP) in Abdominal Aortic Aneurysm (AAA).
Study Start Date :	January 2005
Actual Primary Completion Date :	June 2008
Actual Study Completion Date :	December 2008

Arms and Interventions

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Study Description Study Design Arms and Interventions Outcome Measures Eligibility Criteria Contacts and Locations More Information

Arm	Intervention/treatment
Placebo Comparator: Placebo	Other: Placebo; Placebo given once daily for 4 weeks.
Active Comparator: Statin group	Drug: Atorvastatin; Atorvastatin 80mg, once a day for four weeks.

Outcome Measures

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Primary Outcome Measures :

1. The primary outcome measure was the level of MMP-9 in aortic wall samples of patients on statins and placebo. [ Time Frame: Sample obtained at time of operation ]

Secondary Outcome Measures :

1. The secondary outcome measures were the levels of MMP-2, MMP-8, TIMP-1, TIMP-2 and the variation in areas of peak wall stress due to statins. [ Time Frame: Sample obtained at time of operation ]

Eligibility Criteria

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Ages Eligible for Study:	20 Years and older (Adult, Senior)
Sexes Eligible for Study:	All
Accepts Healthy Volunteers:	No

Criteria

Inclusion Criteria:

• Patient with an AAA >5.5cm diameter listed for open AAA repair at least 3 weeks from screening attendance.

Exclusion Criteria:

• Patients already on statin,
• inability to provide informed written consent,
• contraindication to statin (intrinsic liver disease,
• chronic alcohol abuse, impaired renal function, unstable hypothyroidism,
• unexplained muscle aches, hypersensitivity to atorvastatin or any of its components),
• previous unilateral or bilateral lower limb amputation and concomitant use of fibrates,
• erythromycin,
• immunosuppressive drugs,
• antifungal drugs or lipid lowering drugs.

Contacts and Locations

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Locations

United Kingdom
Hull & east Yorkshire Hospitals NHS Trust
Hull, United Kingdom, HU3 2JZ

Sponsors and Collaborators

University of Hull

Investigators

Principal Investigator:	Ian C Chetter, MBChB, FRCS	Hull Royal Infirmary, Hull, United Kingdom.

More Information

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Study Description Study Design Arms and Interventions Outcome Measures Eligibility Criteria Contacts and Locations More Information

Responsible Party:	Prof. Peter McCollum, Hull Royal Infirmary, Hull, United Kingdom.
ClinicalTrials.gov Identifier:	NCT01062802 History of Changes
Other Study ID Numbers:	CB/EL/R0135
First Posted:	February 4, 2010
Last Update Posted:	February 4, 2010
Last Verified:	December 2007

Additional relevant MeSH terms:

Aneurysm; Aortic Aneurysm; Aortic Aneurysm, Abdominal; Vascular Diseases; Cardiovascular Diseases; Aortic Diseases; Atorvastatin Calcium	Hydroxymethylglutaryl-CoA Reductase Inhibitors; Anticholesteremic Agents; Hypolipidemic Agents; Antimetabolites; Molecular Mechanisms of Pharmacological Action; Lipid Regulating Agents; Enzyme Inhibitors