Aggressive Risk-Prevention Therapies for Coronary Atherosclerotic Plaque (ART-CAP)

Last updated: March 13, 2025
Sponsor: University of Louisville
Overall Status: Trial Not Available

Phase

4

Condition

Heart Defect

Hypercholesterolemia

Atherosclerosis

Treatment

Vascepa

Nexlizet

Colchicine

Clinical Study ID

NCT06280976
23.0001
  • Ages 18-80
  • All Genders

Study Summary

The purpose of this study is to evaluate the role of coronary CT angiogram (CCTA) as a superior guide for the assessment of coronary artery plaque and guiding treatment decisions. The investigators also assess the impact of preventive cardiovascular drugs on the plaque to improve patient outcomes. Participants aged 18-80 years, at intermediate or high-risk for coronary artery disease, with non-obstructive plaque on initial CCTA, will be enrolled in this study. They will be randomized into Standard of Care (SOC) vs. Aggressive Therapy (AT) groups. Both groups will undergo dietary and lifestyle interventions. Follow-up will consist of blood tests and clinic visits at baseline, 9 months, and 18 months. The second CCTA will be performed at 18 months to assess the change in plaque burden, characteristics, ischemia and pericoronary/epicardial fat.

Eligibility Criteria

Inclusion

Inclusion Criteria:

Non-obstructive atherosclerotic coronary artery plaque (stenosis of 0-39% or stenosis of 40-69% with FFR-CT >0.8) in a major epicardial vessel > 2 mm in diameter.

Exclusion

Exclusion Criteria:

  1. coronary/PAD/carotid revascularization or ischemic stroke or TIA within 6 monthsprior to enrollment

  2. Valvular heart disease of moderate or worse severity or requiring interventionalprocedures or surgery

  3. LVEF <35% in the past 12 months

  4. Pulmonary hypertension with PASP>50 mm Hg in the past 12 months

  5. Myocarditis or pericarditis in the past 12 months

  6. Known Cardiomyopathy (hypertrophic, infiltrative, restrictive, dilated, etc.)

  7. Heart failure NYHA class 3 or 4

  8. Hospitalization for heart failure in the preceding 6 months

  9. Life expectancy of <1 year

  10. An organ-transplant recipient or if felt to require listing for solid organtransplantation during study status

  11. Inability to give informed consent

  12. Active malignancy (except basal cell skin cancer)

  13. Cirrhosis

  14. ESRD

  15. Pregnancy or planning to conceive during the study period

  16. Known intolerance or perceived contraindication to any of the study drugs during thestudy period including statins or aspirin if indicated

  17. eGFR<30 ml/min/m2

  18. Inability to receive iodinated contrast for CCTA

  19. Chronic immunosuppression therapy

  20. Uncontrolled psychiatric illness

Study Design

Treatment Group(s): 7
Primary Treatment: Vascepa
Phase: 4
Study Start date:
March 01, 2024
Estimated Completion Date:
January 01, 2025

Study Description

ART-CAP (Aggressive Risk-Prevention Therapies for Coronary Atherosclerotic Plaque ) is a prospective randomized open-label trial with blinded end-point. This research project aims to study the role of coronary computed tomographic angiography (CCTA) as a superior guide for the direct assessment and monitoring of the impact of preventive cardiovascular drugs on coronary artery plaque for better clinical decision-making and improving patient outcomes. Participants aged 18-80 years, at intermediate or high-risk (10-year ASCVD risk of 5-20% or >20%; calculated based on age, gender, race, history of smoking, diabetes mellitus, hypertension, hyperlipidemia, and family history of premature CAD, with/without symptoms suggestive of coronary disease) who has non-obstructive plaque on CCTA (stenosis of 0-39% or 40-69% with FFR-CT >0.8), will be enrolled. Participants with a history of heart attack, coronary stents or bypass surgery, recent stroke, severe valvular heart disease, pulmonary hypertension, NYHA class 3 or 4 heart failure, recent heart failure hospitalization, active cancer, life expectancy of <1 year, end-stage kidney or liver disease, pregnancy or uncontrolled psychiatric illness, will be excluded.

Participants will be randomly assigned to two groups - Standard of Care (SOC, 100 pts) vs. Aggressive Therapy (AT, 100 pts). Both groups will receive dietary and lifestyle interventions. SOC will be treated with statin and/or aspirin as per the ACC guidelines. AT group will be treated with statin, aspirin, nexlizet, leqvio, vascepa, jardiance, and colchicine. Follow-up will consist of blood tests and clinic visits at baseline, 9 months, and 18 months. At baseline, participants will undergo Polygenic Risk Score (PRS) and next-generation sequencing (NGS) for a South Asian gene panel. Biomarker evaluations at baseline, 9 months, and 18 months include lipid profiles, inflammatory markers, cardiac biomarkers, and buffy coat analysis for CHIP, along with standard blood tests including CBC and CMP. Additionally, echocardiographic evaluation will be performed at baseline and 18 months.

After 18 months of medical treatment, a repeat CCTA will be performed to evaluate primary endpoints of the percentage change in plaque burden (total, non-calcified and calcified), plaque characteristics including high-risk features, ischemia value for the most severe lesion, and pericoronary/epicardial fat attenuation. Patient will be followed for additional 5 years for MACCE (major adverse cardiovascular and cerebrovascular events).

Connect with a study center

  • University of Louisville School of Medicine, Division of Cardiovascular Diseases

    Louisville, Kentucky 40202
    United States

    Site Not Available

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