Defining Strategies for Improving Endothelial and Fibrinolytic Dysfunction in Obesity

Study Overview
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Brief Summary
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The combination of high blood pressure and having central obesity is an increasing important factor for heart disease in men and women. It can also lead to the early development of hardening of the arteries and increased risk of a stroke. This study will analyze patients' genetic make up to identify who may be at greater risk for heart disease and strokes in relationship to high blood pressure and central obesity.

Detailed Description
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Obesity is an increasingly important risk factor for cardiovascular disease in men and women and is associated with the premature development of atherosclerosis, and increased risk of stroke. A classical perspective of cardiovascular risk does not adequately explain all of the cardiovascular events associated with obesity. Elevated plasma levels of plasminogen activator inhibitor type I (PAI-1) are one of the biochemical hallmarks for obesity and likely contribute the increased risk of atherothrombotic events in patients with obesity. The central hypothesis of this proposal is that the increased risk of atherothrombotic events in patients with obesity. The central hypothesis of this proposal is that vascular PAI-1 excess promotes the development of intravascular thrombosis. We will test the hypothesis that secreted factors from adipocytes have autocrine, paracrine and endocrine effects that have a deleterious effect on the fibrinolytic system, either by enhancing PAI-1 production or impairing endothelial t-PA release. From a public health perspective, there is no greater threat to America's cardiovascular health than the epidemic of obesity. It is anticipated that this study will provide new insights nto the molecular mechanisms that contribute to the development of fibrinolytic dysfunction and cardiovascular disease in obesity.

Official Title
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Defining Strategies for Improving Endothelial and Fibrinolytic Dysfunction in Obesity

Conditions
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Metabolic Syndrome X

Intervention / Treatment
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* Drug: Eplerenone
* Drug: Ramipril


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Male or females between the ages of 18 to 65 years of age. Documented diagnosis for the metabolic syndrome: Subjects with hypertension (SP>130mmHg) Subjects with central obesity (females waist >35; males waist >40) Subjects with dyslipidemia (HDL <40mg/dl, triglycerides > 150 mg/dl) Subjects who are insulin resistance (fasting glucose >100mg/dl) Exclusion Criteria: Subjects who smoke Women who are pregnant (confirmed by urine beta-HCG). Women who are breast feeding Subjects with documentation of the following health risk: Subjects with serum creatinine >2.0 mg/dl (males), >1.8 mg/dl (females) Subjects whose creatinine clearance < 50 mls/min Subjects with serum potassium >5.5mEql Subjects with Type 2 diabetes with microalbuminuria (spot urine protein/creatinine ration >0.2) Subjects who are currently taking the following medications: Warfarin

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Treatment A<br>Eplerenone (study drug) | Drug: Eplerenone<br>* 5 mg x 1 week followed by 10 mg x 9 weeks.<br>* Other names: Inspra;|
| Active Comparator: Treatment B<br>Ramipril | Drug: Ramipril<br>* Ramipril 5mg qd x 1 week f/b Ramipril qd x 9 weeks.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Secreted Factors From Adipocytes Have Autocrine, Paracrine and Endocrine Effects That Have a Deleterious Effect on the Fibrinolytic System, Either by Enhancing PAI-1 Production or Impairing Endothelial t-PA Release |  | 10-Week period | 
| This Study Will Analyze Patients' Genetic Make up to Identify Who May be at Greater Risk for Heart Disease and Strokes in Relationship to High Blood Pressure and Central Obesity. |  | 10-weeks | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Fibrolytic Dysfunction, Obesity, PAI-1