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Fish Oil and Aspirin With Type 2 Diabetes (R-21)

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. Identifier: NCT01181882
Recruitment Status : Completed
First Posted : August 13, 2010
Last Update Posted : October 8, 2013
Cornell University
Albany College of Pharmacy and Health Sciences
Information provided by (Responsible Party):
Robert Block, University of Rochester

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.

Condition or disease Intervention/treatment Phase
Cardiovascular Disease Dietary Supplement: Fish Oil and Aspirin Phase 2

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.

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 30 participants
Allocation: Non-Randomized
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Official Title: The Effects of Fish Oil and Aspirin on Cardiovascular Risk in Type 2 Diabetes
Study Start Date : August 2010
Actual Primary Completion Date : March 2012
Actual Study Completion Date : November 2012

Resource links provided by the National Library of Medicine

Arm Intervention/treatment
Experimental: Fish Oil and Aspirin Dietary Supplement: Fish Oil and Aspirin
4 grams of fish oil each day for 28 days and 81 mg aspirin
Other Names:
  • Omega-3 EPA/DHA Concentrate
  • Aspirin

Primary Outcome Measures :
  1. Platelet function [ Time Frame: 4 hours ]
    Platelet function effect will be measured with aspirin alone and 4 hours later, after fish oil ingestion.

Secondary Outcome Measures :
  1. Lysophospholipids [ Time Frame: 4 hours ]
    Plasma measurement of lysophospholipids will be measured with aspirin alone and 4 hours later, after fish oil ingestion. These analyses will be considered exploratory due to the fact that no previous data exist regarding the relationships investigated and multiple testing is inherent to these analyses as 11 species of each LPA and LPC will be measured.

Information from the National Library of Medicine

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Ages Eligible for Study:   40 Years to 80 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

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

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 identifier (NCT number): NCT01181882

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United States, New York
Clinical Research Center of the University of Rochester Medical Center
Rochester, New York, United States, 14642
Sponsors and Collaborators
University of Rochester
Cornell University
Albany College of Pharmacy and Health Sciences
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Principal Investigator: Robert C Block, MD, MPH University of Rochester
Publications automatically indexed to this study by Identifier (NCT Number):
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Responsible Party: Robert Block, Assistant Professor, University of Rochester Identifier: NCT01181882    
Other Study ID Numbers: RSRB00030668
First Posted: August 13, 2010    Key Record Dates
Last Update Posted: October 8, 2013
Last Verified: October 2013
Keywords provided by Robert Block, University of Rochester:
Cardiovascular Disease
Aspirin Resistance
Diabetes Mellitus, Type 2
Platelet Function
Omega-3 Fatty Acids
Lysophosphatidic Acid
Additional relevant MeSH terms:
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Cardiovascular Diseases
Anti-Inflammatory Agents, Non-Steroidal
Analgesics, Non-Narcotic
Sensory System Agents
Peripheral Nervous System Agents
Physiological Effects of Drugs
Anti-Inflammatory Agents
Antirheumatic Agents
Fibrinolytic Agents
Fibrin Modulating Agents
Molecular Mechanisms of Pharmacological Action
Platelet Aggregation Inhibitors
Cyclooxygenase Inhibitors
Enzyme Inhibitors