Defining Strategies for Improving Endothelial and Fibrinolytic Dysfunction in Obesity

Phase 4

Terminated

Brief Summary: The combination of high blood pressure and having central obesity is an increasing important factor for heart disease in men and women. It can also lead to the early development of hardening of the arteries and increased risk of a stroke. This study will analyze patients' genetic make up to identify who may be at greater risk for heart disease and strokes in relationship to high blood pressure and central obesity.

Detailed Description: Obesity is an increasingly important risk factor for cardiovascular disease in men and women and is associated with the premature development of atherosclerosis, and increased risk of stroke. A classical perspective of cardiovascular risk does not adequately explain all of the cardiovascular events associated with obesity. Elevated plasma levels of plasminogen activator inhibitor type I (PAI-1) are one of the biochemical hallmarks for obesity and likely contribute the increased risk of atherothrombotic events in patients with obesity. The central hypothesis of this proposal is that the increased risk of atherothrombotic events in patients with obesity. The central hypothesis of this proposal is that vascular PAI-1 excess promotes the development of intravascular thrombosis. We will test the hypothesis that secreted factors from adipocytes have autocrine, paracrine and endocrine effects that have a deleterious effect on the fibrinolytic system, either by enhancing PAI-1 production or impairing endothelial t-PA release. From a public health perspective, there is no greater threat to America's cardiovascular health than the epidemic of obesity. It is anticipated that this study will provide new insights nto the molecular mechanisms that contribute to the development of fibrinolytic dysfunction and cardiovascular disease in obesity.

Recruitment & Eligibility

Inclusion Criteria

Exclusion Criteria

Subjects who smoke
Women who are pregnant (confirmed by urine beta-HCG).
Women who are breast feeding
Subjects with documentation of the following health risk:
- Subjects with serum creatinine >2.0 mg/dl (males), >1.8 mg/dl (females)
- Subjects whose creatinine clearance < 50 mls/min
- Subjects with serum potassium >5.5mEql
- Subjects with Type 2 diabetes with microalbuminuria (spot urine protein/creatinine ration >0.2)
Subjects who are currently taking the following medications:
Warfarin

Arm && Interventions

Group	Intervention	Description
Treatment B	Ramipril	Ramipril
Treatment A	Eplerenone	Eplerenone (study drug)

Primary Outcome Measures

Name	Time	Method
This Study Will Analyze Patients' Genetic Make up to Identify Who May be at Greater Risk for Heart Disease and Strokes in Relationship to High Blood Pressure and Central Obesity.	10-weeks
Secreted Factors From Adipocytes Have Autocrine, Paracrine and Endocrine Effects That Have a Deleterious Effect on the Fibrinolytic System, Either by Enhancing PAI-1 Production or Impairing Endothelial t-PA Release	10-Week period

Secondary Outcome Measures