Peripheral Arterial Disease
Conditions
Keywords
PAD, Peripheral Arterial Disease, Diabetes, Atherosclerosis, Flax, Flaxseeds, Functional Foods, Essential Fatty Acids, Winnipeg
Brief summary
This Clinical Trial is being conducted to study how patients with peripheral arterial disease (a condition in which the blood vessels of the extremities are affected) respond to a dietary regimen of flaxseed. The purpose of the study is to examine whether or not dietary flaxseed have any effect on improving symptoms of cardiovascular disease. Additionally, the effects of dietary flaxseed on exercise tolerance will be assessed.
Detailed description
The proposed trial is a one year, double blinded, placebo controlled study designed to examine and compare the effects of dietary ground flaxseed supplementation in volunteers with claudication secondary to lower extremity atherosclerotic arterial disease (peripheral arterial disease). The original proposal was for a two year study duration but this was truncated at one year to insure patient compliance remained high. This patient population is likely to benefit from flaxseed because there is a high prevalence of accelerated atherosclerosis and a higher than normal incidence of arrhythmias, myocardial infarctions and stroke. This study will be focus on whether dietary flaxseed can reduce clinical manifestations of peripheral arterial disease and increase exercise capacity in these patients. Two general hypotheses will be tested in this proposal. First, we hypothesize that fewer primary and secondary events (all-cause mortality, cardiovascular mortality, stroke, myocardial infarctions, angina, arrhythmias) will occur in patients who ingest flaxseed in their diet. Secondly, we hypothesize that dietary flaxseed supplementation will be associated with beneficial effects on exercise performance, blood pressure and circulating lipid levels. This trial will generate data on the safety, tolerability, cardiovascular efficacy and genomic response to a diet rich in flaxseed in patients with peripheral arterial disease (PAD).
Interventions
DIETARY_SUPPLEMENTFlaxseed
30 grams of milled flaxseed per day in food products or on its own.
DIETARY_SUPPLEMENTPlacebo
Wheat and Mixed Dietary Oils
Sponsors
Dr. Grant Pierce
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
SUPPORTIVE_CARE
Masking
TRIPLE (Subject, Caregiver, Investigator)
Eligibility
Sex/Gender
ALL
Age
40 Years to 100 Years
Healthy volunteers
No
Inclusion criteria
* Subjects with peripheral arterial disease for more than 6 months. * Male or female with claudication secondary to lower extremity atherosclerotic arterial disease. (with limited IC but not incapacitated for walking on the level) confirmed with ankle/brachial pressures\< or = to 0.9 in one or both legs) or who have had a previous intervention for peripheral arterial disease. * Over 40 years old * Able to comply with protocol requirements * Able to provide informed consent * Subjects taking anti-platelet therapy medication must be on a stable dose for 3 months prior to as well as during the study. * Subjects taking lipid lowering medication must be on a stable dose for 3 months prior to as well as during the study.
Exclusion criteria
* Patients with ischemic rest pain in limbs, ulceration, or gangrene. * At baseline, any condition that prevents walking on a treadmill. * History of major bleeding. * Patients with bowel disease (including Crohn's disease, celiac disease, peptic ulcer disease, irritable bowel syndrome and diverticulosis). * Patients with an estimated life expectancy less than 2 years and with high baseline cardiac risk (post ischemic or diabetic cardiomyopathy with EF\<40%, Canadian Cardiovascular Society Class 3 or 4 angina or need for coronary revascularization procedures). * Moderate to severe renal failure. * Subjects that are on supplements other that those prescribed by their clinician for the entire duration of the study. * Fish limitations (no more than 2 fish meals per week) * Gluten allergy * Subjects with allergies to any ingredient in the study product or placebo. * Patients who plan to undergo surgery during the course of the trial.
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Number of Participants With All-cause Mortality, Cardiovascular Mortality, Stroke, and Myocardial Infarctions | 1 year |
Secondary
| Measure | Time frame |
|---|---|
| Effects on Exercise Performance, Blood Pressure and Circulating Lipid Levels. | 1 year |
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Placebo Randomized, Blinded Controlled Arm of patients receiving placebo food products (ie: bagels, muffins, bars, pasta, buns, and milled seeds) containing a mixture of wheat, wheat bran, and mixed dietary oils to replace the flaxseed daily for one year. | 52 |
| Flaxseed Randomized, Blinded group of patients that will be given food products (ie: bagels, muffins, bars, pasta, buns, and milled seeds) containing 30 g of milled flaxseed daily for one year
Flaxseed: 30 grams of milled flaxseed per day in food products or on its own. | 58 |
| Total | 110 |
Baseline characteristics
| Characteristic | Placebo | Flaxseed | Total |
|---|---|---|---|
| Age, Continuous | 65.3 years STANDARD_DEVIATION 9.4 | 67.4 years STANDARD_DEVIATION 8.06 | 67.3 years STANDARD_DEVIATION 8.5 |
| Gender Female | 14 Participants | 15 Participants | 29 Participants |
| Gender Male | 38 Participants | 43 Participants | 81 Participants |
| Region of Enrollment Canada | 52 participants | 58 participants | 110 participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — |
| other Total, other adverse events | 0 / 52 | 3 / 58 |
| serious Total, serious adverse events | 9 / 52 | 15 / 58 |
Outcome results
Primary
Number of Participants With All-cause Mortality, Cardiovascular Mortality, Stroke, and Myocardial Infarctions
Time frame: 1 year
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Placebo | Number of Participants With All-cause Mortality, Cardiovascular Mortality, Stroke, and Myocardial Infarctions | 4 participants |
| Flaxseed | Number of Participants With All-cause Mortality, Cardiovascular Mortality, Stroke, and Myocardial Infarctions | 5 participants |
Secondary
Effects on Exercise Performance, Blood Pressure and Circulating Lipid Levels.
Time frame: 1 year
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Placebo | Effects on Exercise Performance, Blood Pressure and Circulating Lipid Levels. | Final Systolic Blood Pressure | 145.6 mmHg | Standard Error 3.4 |
| Placebo | Effects on Exercise Performance, Blood Pressure and Circulating Lipid Levels. | Final Diastolic Blood Pressure | 78.5 mmHg | Standard Error 1.5 |
| Flaxseed | Effects on Exercise Performance, Blood Pressure and Circulating Lipid Levels. | Final Systolic Blood Pressure | 136.2 mmHg | Standard Error 3.8 |
| Flaxseed | Effects on Exercise Performance, Blood Pressure and Circulating Lipid Levels. | Final Diastolic Blood Pressure | 71.8 mmHg | Standard Error 1.7 |