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Trial registered on ANZCTR
Registration number
ACTRN12624000400561
Ethics application status
Approved
Date submitted
26/02/2024
Date registered
3/04/2024
Date last updated
25/04/2024
Date data sharing statement initially provided
3/04/2024
Type of registration
Prospectively registered
Titles & IDs
Public title
Coronary Artery disease SCreening in young ADult relativEs of individuals with premature Myocardial Infarction (CASCADE-MI study)
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Scientific title
Coronary Artery disease SCreening in young ADult relativEs of individuals with premature Myocardial Infarction (CASCADE-MI study)
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Secondary ID [1]
311605
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Nil
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Universal Trial Number (UTN)
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Trial acronym
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
Myocardial infarction
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Coronary artery disease
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Risk factors
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Condition category
Condition code
Cardiovascular
329709
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0
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Coronary heart disease
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
CT coronary angiography plus routine cardiovascular risk factor assessment.
- CT coronary angiography will be performed at an accredited centre and typically will involve less than 1 hour of the participant's time. An intravenous cannula will be required for iodinated contrast to be administered during the scan.
- The routine cardiovascular risk factor assessment will be performed over 15-30 minutes clinic by a Cardiologist and will involve a clinical assessment of risk factors, medications, physical exam findings, blood tests and calculation of risk using the Australian CVD risk calculator.
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Intervention code [1]
328059
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Early detection / Screening
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Comparator / control treatment
Routine cardiovascular risk factor assessment
- The routine cardiovascular risk factor assessment will be performed over 15-30 minutes clinic by a Cardiologist and will involve a clinical assessment of risk factors, medications, physical exam findings, blood tests and calculation of risk using the Australian CVD risk calculator.
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Control group
Active
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Outcomes
Primary outcome [1]
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Difference in low-density lipoprotein cholesterol (LDL-C) level at 1 year between the two arms
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Assessment method [1]
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Blood test for lipid profile
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Timepoint [1]
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1 year follow-up
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Secondary outcome [1]
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Cardiovascular risk factor profile in adult family members of individuals with premature MI.
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Assessment method [1]
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Risk factor assessment in clinic
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Timepoint [1]
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Baseline (at single screening assessment)
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Secondary outcome [2]
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Difference in use of preventive medications (i.e., statins) between two arms.
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Assessment method [2]
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Interview with patient or medication prescription records by GP
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Timepoint [2]
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3 months and 1 year post-screening
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Secondary outcome [3]
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Differences in adherence to healthy lifestyle between two arms.
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Assessment method [3]
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Questionnaire including the World Health Organisation Global Physical Activity Questionnaire
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Timepoint [3]
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3 months and 1 year post-screening
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Secondary outcome [4]
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Cost-effectiveness of computed tomography coronary angiography for screening in this cohort.
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Assessment method [4]
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Costs of the scan and preventive medication use will be analysed and compared with projected cardiovascular risk and potential risk reduction. Data will be collected from audit of patient electronic medical records, interview with patient or from medication prescription records by GP.
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Timepoint [4]
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1 year post-screening
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Secondary outcome [5]
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Burden of coronary artery disease on computed tomography coronary angiography in adult family members of individuals with premature MI.
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Assessment method [5]
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Computed tomography coronary angiography
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Timepoint [5]
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Baseline (at single screening assessment)
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Eligibility
Key inclusion criteria
Apparently healthy first-degree relative aged 30 to 55 years of a patient with myocardial infarction at premature age (<55 years).
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Minimum age
30
Years
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Maximum age
55
Years
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Sex
Both males and females
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Can healthy volunteers participate?
Yes
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Key exclusion criteria
Exclusion criteria for the apparently healthy relative will include:
• History of cardiovascular disease (i.e., coronary artery disease, peripheral arterial disease, or cerebrovascular disease).
• Already taking aspirin or statin.
• History of iodinated contrast allergy/anaphylaxis.
• Known renal impairment with estimated glomerular filtration rate <45 ml/min/1.73m2.
• Unwilling or unable to provide informed consent.
• Pregnant women.
Exclusion criteria for the index case (patient) will include the following diagnoses:
• Non-atherosclerotic cause of myocardial infarction such as spontaneous coronary artery dissection, paradoxical venous thrombo-embolism, myocarditis, pericarditis, vasospasm, and Takotsubo cardiomyopathy.
• Myocardial infarction with nonobstructive coronary arteries.
• Probable or definite familial hypercholesterolaemia by the Dutch Lipid Clinic Network Criteria (score 6 or more).
• Age <18 years.
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Study design
Purpose of the study
Prevention
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Allocation to intervention
Randomised controlled trial
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Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
Allocation concealment will be performed through central randomisation by a computer.
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
Randomisation will be performed by computer software, accounting for the cluster randomised design where family members will be randomised to the same arm.
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Masking / blinding
Open (masking not used)
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Who is / are masked / blinded?
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Intervention assignment
Parallel
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Other design features
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Phase
Not Applicable
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Type of endpoint/s
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Statistical methods / analysis
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Recruitment
Recruitment status
Not yet recruiting
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Date of first participant enrolment
Anticipated
1/07/2024
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Actual
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Date of last participant enrolment
Anticipated
31/12/2025
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Actual
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Date of last data collection
Anticipated
1/12/2026
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Actual
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Sample size
Target
300
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Accrual to date
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Final
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Recruitment in Australia
Recruitment state(s)
WA
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Funding & Sponsors
Funding source category [1]
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Government body
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Name [1]
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South Metropolitan Health Service
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Address [1]
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Country [1]
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Australia
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Primary sponsor type
University
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Name
Curtin University
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Address
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Country
Australia
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Secondary sponsor category [1]
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None
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Name [1]
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Address [1]
318063
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Country [1]
318063
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Ethics approval
Ethics application status
Approved
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Ethics committee name [1]
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South Metropolitan Health Service Human Research Ethics Committee
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Ethics committee address [1]
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https://smhs.health.wa.gov.au/Our-research/For-researchers
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Ethics committee country [1]
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Australia
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Date submitted for ethics approval [1]
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23/01/2024
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Approval date [1]
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21/03/2024
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Ethics approval number [1]
314759
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Summary
Brief summary
Premature cardiovascular disease (CVD) remains a significant cause of morbidity and mortality despite advances in prevention. Patients with myocardial infarction (MI) at a young age represent a unique cohort, with differences in cardiovascular (CV) risk factor profile, underlying pathophysiology, and coronary plaque compared with their older counterparts. In young patients with MI, genetic predisposition contributes to the development of coronary artery disease (CAD). Indeed, family history of premature CVD is a well-recognised risk factor for MI. It is therefore recommended that family members of patients with premature MI undergo CV risk assessment. There are risk scores available for CV risk assessment, such as the Australian CVD risk calculator, which estimates 5-year CVD risk based on clinical factors. Cardiac imaging has shifted the playing field regarding non-invasive detection and assessment of subclinical atherosclerosis. However, cardiac imaging is not currently recommended for large-scale screening in asymptomatic patients but may improve CV risk-stratification and guide use of preventive medications in certain individuals. Families with premature CAD are a high-risk cohort that remain a neglected target for primary prevention. In 300 adult first-degree relatives of individuals with premature MI, this randomised trial will aim to assess whether addition of computed tomography coronary angiography (CTCA) to routine CV risk factor assessment can lead to superior primary prevention low-density lipoprotein cholesterol (LDL-C) levels
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Trial website
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Trial related presentations / publications
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Public notes
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Contacts
Principal investigator
Name
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Dr Abdul Rahman Ihdayhid
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Address
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Fiona Stanley Hospital - 11 Robin Warren Drive, Murdoch WA 6155
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Country
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Australia
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Phone
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+61 8 61511246
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Fax
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Email
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[email protected]
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Contact person for public queries
Name
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Nick Lan
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Address
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Fiona Stanley Hospital - 11 Robin Warren Drive, Murdoch WA 6155
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Country
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Australia
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Phone
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+61 8 61511246
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Fax
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Email
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[email protected]
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Contact person for scientific queries
Name
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Nick Lan
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Address
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Fiona Stanley Hospital - 11 Robin Warren Drive, Murdoch WA 6155
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Country
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Australia
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Phone
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+61 8 61511246
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Fax
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Email
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[email protected]
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Data sharing statement
Will individual participant data (IPD) for this trial be available (including data dictionaries)?
No
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No/undecided IPD sharing reason/comment
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What supporting documents are/will be available?
No Supporting Document Provided
Results publications and other study-related documents
Documents added manually
No documents have been uploaded by study researchers.
Documents added automatically
No additional documents have been identified.
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