Where to Find Coronary Artery Disease Clinical Trials
If you have been diagnosed with Coronary Artery Disease (CAD) and you are looking for information on how to join clinical trials, you are in the right place. Since over 900,000 individuals will suffer a heart attack or die from Coronary Artery Disease this year alone, coronary artery disease is a huge priority for researchers. There are many opportunities available to join ongoing and upcoming clinical trials focusing on coronary artery disease.
However, since there are also so many patients with coronary artery disease, you have to be your own advocate if you are trying to get into a clinical trial. But, there is a lot of important information you need to know before you sign up! We cover the most important parts of joining a clinical trial for coronary artery disease in this article.
What is Coronary Artery Disease (Coronary Heart Disease)?
The symptoms of coronary artery disease (a.k.a. coronary or ischemic heart disease) most often include chest pain, though some patients experience light-headedness, fibrillation (a fluttering heartbeat), or weakness in the arms and shoulders. If you are experiencing any of these symptoms, please stop reading now and call an ambulance. These symptoms are likely due to obstructive blockages in the arteries that feed your heart (sometimes called stenosis), and they can quickly become a life-threatening heart attack and often require hospitalization and catheterization.
Coronary artery disease (CAD) is a type of cardiovascular disease affecting the arteries that feed the heart. When these arteries become clogged, the heart can no longer get enough oxygen to function. Since the heart is essentially just a muscle, a lack of oxygen due to blocked arteries can quickly lead to the death of heart tissue and heart failure. This ischemia (low blood flow) is typically what causes acute coronary syndrome and the chest pain (a.k.a. angina) associated with CAD. Full on heart failure caused by an obstruction in the coronary vascular system is known as a myocardial infarction.
Your cardiologist can confirm your CAD using a variety of methods, including coronary angiography which uses a specialized dye to visualize blockages in the ventricular arteries. Though coronary artery disease and myocardial infarction are highly correlated with diet and exercise, there are also certain genetic components that may play a role in cardiology.
Genetics of Coronary Artery Disease
Though the genetics of coronary artery disease is extremely complex, scientists have located around 60 different locations within the human genome that are related to a person’s risk of developing coronary artery disease. The genes at these locations control a wide variety of proteins within the circulatory system that can contribute to coronary artery disease. For instance, certain genetic variants are related to changes in lipoproteins that control fat deposits in your bloodstream. Other genetic variants control the structure of the arteries themselves.
Unfortunately, much more work needs to be done to accurately predict if the genetic variants you carry significantly impact your risk factors for coronary artery disease. Though specific genetic variants certainly carry an increased risk, the interaction between all of these genes and the environment can modify your overall risk factors in ways science does not yet fully understand. Some genetic testing companies, like 23andMe, do offer DNA health tests that attempt to quantify if you have an increased risk based on some of these genes.
Are there Treatments for Coronary Artery Disease?
There are many available treatments for the various symptoms of coronary artery disease. Which treatment your doctor prescribes is based mostly on how severe the disease has progressed, and how clogged your arteries are.
If you have not yet had a heart attack, the most commonly prescribed treatments include lifestyle changes. By reducing the salt and fat content of your diet and engaging in more exercise, you may be able to partly restore function to your coronary arteries. However, more severe cases of CAD can require more intense treatments and follow-up.
There are many drugs on the market that can treat high cholesterol (like statins), hypertension, and high blood pressure. These are all factors that greatly increase the risk of CAD leading to a heart attack. Other medications are inhibitors that can prevent heart attacks (like clopidogrel) and promote revascularization of the heart tissue. Most medications by themselves do not treat the underlying cause of coronary artery disease, and most patients also require lifestyle interventions. The most severe cases of coronary artery disease require angioplasty (a procedure to expand the coronary arteries), a Percutaneous coronary intervention (PCI), a stent, or even coronary artery bypass surgery to completely circumvent the blocked arteries. These treatments often require significant follow-up healthcare and hospitalization.
What Are Clinical Trials?
Clinical trials are the final stage of testing a drug or medical therapy before the treatment can be offered safely to the general public. While drugs and interventions that have made it to the clinical trial phase have a higher probability of being safe and effective, there are still many aspects of safety and efficacy that are being investigated. Some clinical trial participants are just there to set the baseline. For instance, researchers might measure an infarct (dead tissue) in both intervention patients and control patients to see if the treatment is working better than the normal outcome.
Clinical trials typically have 3 phases. Phase 1 clinical trials typically use a very small number of volunteers to ensure that the treatment does not cause any serious side effects in humans. These studies may reach a primary endpoint before the treatment is complete. In Phase 2 trials, the pool of volunteers is expanded considerably and researchers can better monitor the outcomes and efficacy of the treatment. Phase 3 trials are the last stage before a drug or intervention can be approved. These final set of trials include thousands of participants and monitor the drug and intervention for both efficacy and safety in a large group.
Why Do People Join Clinical Trials?
Contrary to popular belief, most people do not join clinical trials to get access to the latest and “best” treatments for a disease. In fact, clinical trials have no guarantee of safety or efficacy - unlike drugs that have already been approved by the Food and Drug Administration (FDA). Most people join clinical trials to help scientists discover and test new treatments.
In the case of coronary artery disease, most clinical trial participants recognize the severity of the disease and want to help find new treatments and interventions to help other people with the disease. There is always a chance that you will receive a revolutionary new drug or treatment, but in most clinical trials there is an equal chance you will unknowingly be on a placebo. This could be a sugar pill or other innocuous treatment that helps researchers determine how effective their new drug or interventional treatment is, which can help the FDA label the drug as safe and effective.
Keep in mind that some clinical trials are simply observational studies used to determine certain outcomes such as quality of life or a secondary prevention technique. For example, a study might just measure the ejection fraction (amount of blood) that your heart pumps on different medications Some studies are multicenter studies carried out in clinics around the world, while others are much smaller and more localized. The size of a study does not necessarily change the risk patients face.
Where to Find Clinical Trials for Coronary Artery Disease
Fortunately, there are many places you can find clinical trials for coronary artery disease. The more information you have about your disease, the better. Most clinical trials are looking for a very specific type of patient to perform interventions on, so don’t be upset if you are disqualified from certain studies for any reason. Cardiology trials can be very specific. For instance, they may ask you if you have had atherosclerosis, lesions, or any percutaneous coronary interventions in the past. If you do not know the answers to these questions, you can consult your doctor or cardiologist and have them help you
Below are some of the best websites to find clinical trial enrollment across the United States:
- ClinicalTrials.gov - Coronary Artery Disease
- Mayo Clinic - Coronary Artery Disease Clinical Trials
- Center Watch - CAD Clinical Trials
- American Heart Association - Clinical Research Studies
While the sites above are great resources for locating clinical trials across the country, you should also check with your cardiologist and any hospitals or clinics that specialize in heart care in your area. The professionals at these centers are often conducting trials in partnership with local universities.
Centers for Disease Control (CDC) - Coronary Artery Disease
National Review of Genetics - Genetics of coronary artery disease: discovery, biology and clinical translation
JAMA Cardiology - Assessing the role of rare genetic variation in patients with heart failure