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Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in the United States with older age being a primary risk factor. The number of adults greater than age 65 years will almost double to 70 million by 2030, therefore identifying therapeutic strategies for treating or preventing age-related disorders in humans is of major biomedical importance. Cardiovascular aging, defined as a reduction in vascular and cardiac functions with normal aging, occurs even in the absence of CVD risk factors and overt CVD. A key feature of cardiovascular aging is stiffening of the large elastic central arteries such as the aorta. This is important because aortic stiffness directly contributes to clinical problems such as increased blood pressure, reduced blood flow to the heart muscle, and thickening of the heart muscle. Therefore, these clinical consequences are hypothesized to mediate a substantial proportion of the increase in CVD risk in older adults. However, effective drug treatments for aortic stiffness are not currently available and the biological reasons (mechanisms) involved in causing aortic stiffening remain undefined. In addition, the inability of smaller blood vessels to relax, impairment of the heart to relax during the filling phase of the heart cycle (i.e., diastole), and increased blood pressure variability, have all been linked to aortic stiffness. Furthermore, chronic low-grade inflammation with advancing age has been proposed to be a common mechanistic link (i.e., biological reason) between these reductions in cardiovascular function in older adults. Therefore, the investigators propose that inflammation could be a novel therapeutic target to treat cardiovascular aging in older adults. Our central hypothesis is that inflammation mediates the age-related deterioration in cardiovascular functions observed with advancing age through the development of oxidative stress (i.e., imbalance between damaging oxygen free radicals vs. protective antioxidants). Our hypothesis predicts that chronic inhibition of inflammation with Salsalate, an FDA-approved anti-inflammatory drug similar to aspirin that is used to treat rheumatoid arthritis pain and known to inhibit the 'master' regulator of inflammation in the cell (i.e., nuclear factor kappa B), will improve cardiovascular function in older adults. In addition, the investigators hypothesize that the mechanism for the improvement in cardiovascular function during inhibition of inflammation will be by suppressing oxidative stress. To test our hypothesis, the investigators will randomize older healthy adults (age 50-79 years) to 3 g/day of salsalate or placebo (i.e., pill with inactive substance) pills for 4 weeks and have cardiovascular function measured at baseline and again after 4 weeks.
Aim 1: To measure aortic wall stiffness and circulating biomarkers of oxidative stress during both acute (IV) intravenous infusions of saline and then the antioxidant vitamin C at baseline and after 4 weeks of salsalate or placebo in healthy older adults. Hypothesis 1: Inhibition of inflammation in older adults will decrease aortic wall stiffness in part by reductions in oxidative stress.
Aim 2: To measure brachial artery endothelium-dependent vasodilation (EDV) and circulating markers of oxidative stress during acute intravenous infusions of saline and then the vitamin C at baseline and after 4 weeks of salsalate or placebo in healthy older adults. Hypothesis 2: Inhibition of inflammation in older adults will improve vascular endothelial vasodilatory function in older adults in part by reductions in oxidative stress.
Aim 3: To measure left ventricular (LV) diastolic relaxation and filling dynamics and circulating markers of oxidative stress during both acute intravenous infusions of saline and then vitamin C at baseline and after 4 weeks of Salsalate or placebo in healthy older adults. Hypothesis 3: Inhibition of inflammation in older adults will improve LV diastolic function in part by reductions in oxidative stress.
Exploratory Aim: To measure 24-hour pressure variability and short-term baroreflex sensitivity before and after 4 weeks of oral Salsalate or placebo treatment in older adults. Exploratory hypothesis: Inhibition of inflammation in older adults will improve cardiovascular autonomic dysregulation in older healthy adults.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Salsalate | Experimental | Salsalate capsule 1.5 g/day twice per day by mouth for 4 weeks |
|
| Placebo | Placebo Comparator | Placebo capsule twice per day by mouth for 4 weeks |
|
| Young Control | No Intervention | No intervention; Baseline measurements only |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Salsalate | Drug | 4 weeks of daily salsalate |
|
|
| Measure | Description | Time Frame |
|---|---|---|
| Carotid-femoral Pulse Wave Velocity (CFPWV) | Aortic stiffness | Change in CFPWV from baseline at 4 weeks |
| Measure | Description | Time Frame |
|---|---|---|
| Brachial Artery Flow-mediated Dilation (FMD) | Endothelial function | Change from baseline brachial artery FMD at 4 weeks |
| Measure | Description | Time Frame |
|---|---|---|
| Tissue Doppler Left Ventricular Relaxation Velocity (E') | Left ventricular diastolic dysfunction | Change from baseline E' at 4 weeks |
Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Gary L Pierce, PhD | University of Iowa | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| University of Iowa | Iowa City | Iowa | 52242 | United States |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 19337387 | Background | Goldfine AB, Silver R, Aldhahi W, Cai D, Tatro E, Lee J, Shoelson SE. Use of salsalate to target inflammation in the treatment of insulin resistance and type 2 diabetes. Clin Transl Sci. 2008 May;1(1):36-43. doi: 10.1111/j.1752-8062.2008.00026.x. | |
| 17959861 | Background | Fleischman A, Shoelson SE, Bernier R, Goldfine AB. Salsalate improves glycemia and inflammatory parameters in obese young adults. Diabetes Care. 2008 Feb;31(2):289-94. doi: 10.2337/dc07-1338. Epub 2007 Oct 24. |
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A total of 59 participants were consented/enrolled. A total of 13 were excluded or lost to follow up after consent (n=8 did not meet inclusion criteria after screening; n=1 lost to follow up; n=1 time committment; n=1 moved out of state; n=2 other).
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| ID | Title | Description |
|---|---|---|
| FG000 | Salsalate | Salsalate capsule 1.5 g twice per day by mouth for 4 weeks Salsalate |
| FG001 | Placebo | Placebo capsule twice per day by mouth for 4 weeks Placebo (for salsalate) |
| FG002 | Young Control | No intervention; Baseline measurements only, participants not randomized |
| Title | Milestones | Reasons Not Completed | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Overall Study |
|
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| ID | Title | Description |
|---|---|---|
| BG000 | Salsalate | Salsalate capusule 1.5 g twice per day by mouth for 4 weeks |
| BG001 | Placebo | Placebo capsule twice per day by mouth for 4 weeks |
| Units | Counts |
|---|---|
| Participants |
|
| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes |
|---|---|---|---|---|---|---|---|---|---|
| Age, Continuous | Mean |
| Type | Title | Description | Population Description | Reporting Status | Anticipated Posting Date | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Time Frame | Units Analyzed | Denominator Units Selected | Arm/Group Information | Denominators | Classes | Analyses | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Primary | Carotid-femoral Pulse Wave Velocity (CFPWV) | Aortic stiffness | After baseline measurements, there were 3 dropouts in salsalate group for a total of 11 completed in salsalate, and 1 dropout in the placebo group for a total of 13 completed in placebo. | Posted | Mean | Standard Error | cm/sec | Change in CFPWV from baseline at 4 weeks |
|
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| ID | Title | Description | Deaths (Affected) | Deaths (At Risk) | Serious Events (Affected) | Serious Events (At Risk) | Other Events (Affected) | Other Events (At Risk) |
|---|---|---|---|---|---|---|---|---|
| EG000 | Salsalate | Salsalate 1.5 g twice per day by mouth for 4 weeks | 0 |
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| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| Elevated AST/ALT | Hepatobiliary disorders | Systematic Assessment | Elevated serum AST/ALT after 2 weeks of salsalate that resolved within 7 days after stopping medications without complication |
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| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Gary Pierce | University of Iowa | 319-335-9487 | gary-pierce@uiowa.edu |
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| ID | Term |
|---|---|
| D007249 | Inflammation |
| ID | Term |
|---|---|
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
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| ID | Term |
|---|---|
| C014182 | salicylsalicylic acid |
| D000073893 | Sugars |
| ID | Term |
|---|---|
| D002241 | Carbohydrates |
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| Placebo (for salsalate) | Drug | 4 week of daily placebo |
|
|
| 20231565 | Background | Goldfine AB, Fonseca V, Jablonski KA, Pyle L, Staten MA, Shoelson SE; TINSAL-T2D (Targeting Inflammation Using Salsalate in Type 2 Diabetes) Study Team. The effects of salsalate on glycemic control in patients with type 2 diabetes: a randomized trial. Ann Intern Med. 2010 Mar 16;152(6):346-57. doi: 10.7326/0003-4819-152-6-201003160-00004. |
| 21617098 | Background | Chai W, Liu J, Jahn LA, Fowler DE, Barrett EJ, Liu Z. Salsalate attenuates free fatty acid-induced microvascular and metabolic insulin resistance in humans. Diabetes Care. 2011 Jul;34(7):1634-8. doi: 10.2337/dc10-2345. Epub 2011 May 26. |
| 21115878 | Background | Jablonski KL, Chonchol M, Pierce GL, Walker AE, Seals DR. 25-Hydroxyvitamin D deficiency is associated with inflammation-linked vascular endothelial dysfunction in middle-aged and older adults. Hypertension. 2011 Jan;57(1):63-9. doi: 10.1161/HYPERTENSIONAHA.110.160929. Epub 2010 Nov 29. |
| 20080359 | Background | McCarty MF. Salsalate may have broad utility in the prevention and treatment of vascular disorders and the metabolic syndrome. Med Hypotheses. 2010 Sep;75(3):276-81. doi: 10.1016/j.mehy.2009.12.027. Epub 2010 Jan 18. |
| 19237660 | Background | Pierce GL, Lesniewski LA, Lawson BR, Beske SD, Seals DR. Nuclear factor-kappaB activation contributes to vascular endothelial dysfunction via oxidative stress in overweight/obese middle-aged and older humans. Circulation. 2009 Mar 10;119(9):1284-92. doi: 10.1161/CIRCULATIONAHA.108.804294. Epub 2009 Feb 23. |
| 21303813 | Background | Lesniewski LA, Durrant JR, Connell ML, Folian BJ, Donato AJ, Seals DR. Salicylate treatment improves age-associated vascular endothelial dysfunction: potential role of nuclear factor kappaB and forkhead Box O phosphorylation. J Gerontol A Biol Sci Med Sci. 2011 Apr;66(4):409-18. doi: 10.1093/gerona/glq233. Epub 2011 Feb 8. |
| BG002 | Young Control | No intervention, not randomized; Baseline measurements only |
| BG003 | Total | Total of all reporting groups |
| Years |
|
| Sex: Female, Male | Count of Participants | Participants |
|
No Intervention; Baseline measurements only, participants not randomized |
|
|
| Secondary | Brachial Artery Flow-mediated Dilation (FMD) | Endothelial function | After baseline measurements, there were 3 dropouts in salsalate group and 1 FMD that was not able to be anayzed (poor image quality) for a total of 10 in salsalate for FMD. There was 1 dropout in the placebo group and 2 FMDs not analyzed (poor image quality) for a total of 11 analyzed in placebo for FMD. | Posted | Mean | Standard Error | Percent dilation | Change from baseline brachial artery FMD at 4 weeks |
|
|
|
| Other Pre-specified | Tissue Doppler Left Ventricular Relaxation Velocity (E') | Left ventricular diastolic dysfunction | Data were not obtained because cardiac echos could not be performed in participants because of lack of equipment | Posted | Change from baseline E' at 4 weeks |
|
|
| 14 |
| 0 |
| 14 |
| 1 |
| 14 |
| EG001 | Placebo | Placebo capusule twice per day by mouth for 4 weeks | 0 | 14 | 0 | 14 | 1 | 14 |
| EG002 | Young Control Group | No intervention; Baseline measurements only; Participants not randomized | 0 | 17 | 0 | 17 | 0 | 17 |
|
| Allergic reaction | Eye disorders | Non-systematic Assessment | One participant in placebo group developed allergic reaction (facial / orbital swelling) but after withdrawl from study and PI unblinded it was determined that the participant was in the placebo group. Follow up likley allergy to shellfish. |
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| 4 Weeks |
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