Pragmatic Evaluation of Events And Benefits of Lipid-lowering in Older Adults
Purpose
PREVENTABLE is a multi-center, randomized, parallel group, placebo-controlled superiority study. Participants will be randomized 1:1 to atorvastatin 40 mg or placebo. This large study conducted in community-dwelling older adults without cardiovascular disease (CVD) or dementia will demonstrate the benefit of statins for reducing the primary composite of death, dementia, and persistent disability and secondary composites including mild cognitive impairment (MCI) and cardiovascular events.
Conditions
- Cognitive Impairment, Mild
- Dementia
- Cardiovascular Diseases
Eligibility
- Eligible Ages
- Over 75 Years
- Eligible Genders
- All
- Accepts Healthy Volunteers
- Yes
Inclusion Criteria
- Community-dwelling adults - Age ≥75 years - English or Spanish as primary language
Exclusion Criteria
- Clinically evident cardiovascular disease defined as prior myocardial Infarction (MI), prior stroke, prior revascularization procedure, or a secondary prevention indication for a statin (clinician determined) - Hospitalization for a primary diagnosis of heart failure in the prior 12 months (Note: History of heart failure in the absence of recent hospitalization or clinically evident cardiovascular disease is not an exclusion) - Dementia (clinically evident or previously diagnosed) - Dependence in any Katz Basic Activities of Daily Living [ADL] (with the exception of urinary or bowel continence) - Severe hearing impairment (preventing phone follow up) - Unable to talk (preventing phone follow up) - Severe visual impairment (preventing cognitive testing) - Statin use in the past year or for longer than 5 years previously (participant reported) - Ineligible to take atorvastatin 40 mg (clinician determined) - Documented intolerance to statins - Active Liver Disease - Long-term use of daily colchicine, verapamil at any dose, or diltiazem at a dose >240mg/day.
Study Design
- Phase
- Phase 4
- Study Type
- Interventional
- Allocation
- Randomized
- Intervention Model
- Parallel Assignment
- Intervention Model Description
- Randomized 1:1 atorvastatin 40mg vs. placebo
- Primary Purpose
- Prevention
- Masking
- Triple (Participant, Care Provider, Investigator)
Arm Groups
| Arm | Description | Assigned Intervention |
|---|---|---|
|
Experimental atorvastatin 40mg |
40mg atorvastatin po qd from consent to study end |
|
|
Placebo Comparator Placebo |
matching placebo po qd from consent to study end |
|
Recruiting Locations
Birmingham, Alabama 35205
Tucson, Arizona 85723
Little Rock, Arkansas 72114
Little Rock, Arkansas 72204
Long Beach, California 90822
Los Angeles, California 90073
San Diego, California 92161
New Haven, Connecticut 06520
West Haven, Connecticut 006111
Study Coordinator
203-932-5711
Gainesville, Florida 32608
Gainesville, Florida 32610
Jacksonville, Florida 32608
Miami, Florida 33125
Atlanta, Georgia 30033
Chicago, Illinois 60208
Chicago, Illinois 60608
Chicago, Illinois 60612
Chicago, Illinois 60637
Hines, Illinois 60141
North Chicago, Illinois 60064
Indianapolis, Indiana 46202
Iowa City, Iowa 52242
Kansas City, Kansas 64128
Kansas City, Kansas 66160
Louisville, Kentucky 40206
New Orleans, Louisiana 70121
Togus, Maine 04330
Baltimore, Maryland 21287
Boston, Massachusetts 002130
Ann Arbor, Michigan 48105
Ann Arbor, Michigan 48109
Duluth, Minnesota 55805
Rochester, Minnesota 55905
Jackson, Mississippi 39216
Jackson, Mississippi 39216
Columbia, Missouri 65212
Saint Louis, Missouri 63106
Saint Louis, Missouri 63130
Omaha, Nebraska 67105
Omaha, Nebraska 68105
Bronx, New York 10461
Manhasset, New York 11030
New York, New York 10021
Asheville, North Carolina 28805
Chapel Hill, North Carolina 27599
Charlotte, North Carolina 28207
Durham, North Carolina 27701
Khaula Baloch
Durham, North Carolina 27705
Durham, North Carolina 27710
Kannapolis, North Carolina 28081
Winston-Salem, North Carolina 27157
Winston-Salem, North Carolina 27157
Cincinnati, Ohio 45220
Cleveland, Ohio 44106
Dayton, Ohio 45428
Pittsburgh, Pennsylvania 15213
Providence, Rhode Island 002908
Charleston, South Carolina 29401
Charleston, South Carolina 29403
Columbia, South Carolina 29209
Memphis, Tennessee 38104
Nashville, Tennessee 37208
Nashville, Tennessee 37212
Nashville, Tennessee 37212
Dallas, Texas 75210
Dallas, Texas 75216
Dallas, Texas 75390
Edinburg, Texas 78539
Houston, Texas 77204
San Antonio, Texas 78229
Salt Lake City, Utah 84148
Eau Claire, Wisconsin 54703
La Crosse, Wisconsin 54601
Madison, Wisconsin 53705
Marshfield, Wisconsin 54449
Milwaukee, Wisconsin 53295
Milwaukee, Wisconsin 53295
San Juan, Puerto Rico 00921
More Details
- NCT ID
- NCT04262206
- Status
- Recruiting
- Sponsor
- Duke University
Detailed Description
PREVENTABLE will randomly assign atorvastatin 40 mg daily or matching placebo daily to 20,000 community-dwelling adults 75 years of age or older without clinically evident cardiovascular disease, significant disability, or dementia, and follow them for up to 5 years (estimated median of 3.8 years). The study will enroll participants from approximately 100 US sites. Community engagement efforts will leverage community groups and practices as collaborators for recruitment. We plan to partner with participants, caregivers, and clinicians in all aspects of the study. The enrolling sites are non-VA and VA sites. Each site will apply a study-specific cohort identification algorithm to their electronic health record to create a list of eligible participants based on study inclusion and exclusion criteria. The cohort identification will exclude individuals with clinically evident cardiovascular disease, significant disability, or dementia and other exclusions obtainable from data queries to define a potential cohort. Sites will screen potential participants to confirm eligibility and consent and randomize those interested in joining the study. Specifically related to dementia, the qualifying exclusion is a clinical diagnosis in the chart or clinician's assessment that dementia may be present. Sites will enter contact information, mailing address for study drug, demographic information, height, weight, statin history (if any), Social Security Number, and aspects of the medical history not obtainable from EHR. In addition, a Short Physical Performance Battery (SPPB) and Activities of Daily Living (ADL) screen will be site-performed at baseline. SPPB will provide an objective assessment of function for understanding frailty and physical function of the enrolled population. Baseline lipid panel (core lab) and biospecimen samples will be obtained using the same blood draw for 20cc of blood. Blinded lipid testing will be performed at baseline on all participants (n=20,000) and repeated at 3 months in a random subset (n=2,000). Lipid panels will be sent to the PREVENTABLE Core Lab to maintain study blind. Future testing of lipid panels during routine clinical care will be actively discouraged, but other laboratory testing as indicated by clinical care is permitted.Sites will have the option for telehealth enrollment. Baseline SPPB and Biorepository Labs are not required, but encouraged. As part of the study operations, with the rationale of providing patient centricity, ease of participation, and access for vulnerable and at risk participants, follow up will be performed by a combination of central and distributed research teams. This includes a call center as well as a nationwide system of decentralized research staff trained on the protocol able to meet the patient in their home or other desired location. The baseline and annual assessments performed centrally will include a phone screen for cognitive function (TICS-M) and physical function (Patient-reported Outcome Measurement Information System-Physical Function [PROMIS-PF]). After year 1, If baseline calls indicated by crossing pre-specified cutpoints, in-person assessments will be completed by trained and certified research staff at a mutually agreed upon time and a standardized interview of a knowledgeable informant. Cardiovascular event ascertainment will be via a systematic approach to data curation from the EHR, Medicare, and National Death Index. For convenience and compliance, the study pharmacy will mail a supply of study drug, sufficient for 90 days, directly to participants. This will start immediately after randomization and continue as long as the participant is on study drug.