Advances in Molecular Biology and Biotechnology - Annotated Bibliography Example

Advances in Molecular Biology and Biotechnology (Treatment for cardiovascular disease) Word Count: 2205 Key Words Lipoprotein Hypercholesterolemia Atherosclerotic heart disease Statins Immunoglobulin Prednisolone Primary intervention CVD risk factors Acronyms ACE – angiotensin-converting enzyme AGT – angiotensinogen gene RAAS – renin-angiotensin-aldosterone system BMI – body mass index CETP – cholesteryl ester transfer protein CVD – Cardiovascular disease EURIKA – European Study in Cardiovascular Risk Prevention and Management in Usual Daily Practice HDL – high density lipoprotein PAV – per cent atheroma volume LDL-C – low-density lipoprotein cholesterol PCSK9 – Proprotein Convertase Subtilisin/Kexin Type 9 AMG 145 – Amgen WC – waist circumference Introduction With the growing prevalence of cardiovascular diseases across the world, there is need to intensify efforts to enhance prevention and treatment of these diseases. Major steps have already been made towards this end. Various preventive and treatment strategies have been identified and are currently being used. However, as Huffman and Bhatnagar (2012) notes, there are still major gaps in prevention and treatment options for cardiovascular diseases. Preventive treatments form the basis of CVD control and management. Luckily, there have been major strides made in the identification of risk factors for CVD, most of which are controllable. However, a comprehensive treatment of CVD also requires the use of secondary treatments that rely on a combination of various drugs. Some of the latest treatments for CVD include nicotine replacement, antihypertensive medications, lipid-lowering therapies, aspirin, antiplatelet agents, antithrombotic agents, and blood-pressure lowering agents among others. Various studies have been conducted to examine the effectiveness, side effects, tolerability, and safety of these different treatments for CVD. Yet, more focus is on preventive/primary treatment approaches that are based on lifestyle changes to reduce the risk factors. Some of the preventive approaches include changing behaviours such as tobacco smoking, eating healthy diet, engaging in more physical exercise, weight reduction, and managing diabetes (Van Camp, 2014). The application and outcomes of the different preventive and treatment strategies vary depending on various factors. This paper presents an annotated bibliography of 10 research papers that examine the prevention and treatment of cardiovascular diseases and related factors. Most of the research papers show great potential in the use of various preventive and treatment approaches for CVD. Annotated Bibliography Banegas, J. R., López-García, E., Dallongeville, J., Guallar, E., Halcox, J. P., Borghi, C., ... & Rodríguez-Artalejo, F. 2011, ‘Achievement of treatment goals for primary prevention of cardiovascular disease in clinical practice across Europe: The EURIKA study’, European heart journal, vol. 32, no. 17, pp. 2143-2152. Banegas et al., (2011) conducted a study to determine the effectiveness of primary prevention approaches used in the management of CVD. The study used a multi-country sample of individuals with CVD high risk factors including obesity, hypertension, tobacco smoking, and dyslipidaemia. The study used a cross-sectional EURIKA approach for a period of one year. The main finding from the study was that the achievement of treatment goals was low across the board. In most of the CVD risk factors, the findings from the study showed that achievement of treatment goals were below average. The implication from these findings is that the current primary treatment of CVD through control of the risk factors is poor and needs improvement. The problem is not in the primary treatment but in the approach used. Apparently, there is need for a more comprehensive and targeted approach in the primary treatment approaches for CVD. The fact that the study established some proportion of the subjects attained treatment goals means that such approaches can be enhanced to be more effective on a larger scale. Finally, the study supports the use of preventative treatment approaches for CVD because the risk factors are known and can be managed to prevent the onset of CVD. Bo, N., J., Ejg, J., D., Dorte, G., Lind, B., B., & Veldt, L., P. 2014, ‘Determinants for acceptance of preventive treatment against heart disease – a web-based population survey’, BMC Public Health, vol. 14, no. 1, p. 783. Bo et al., (2014) conducted an empirical web-based study to establish the factors that influence the uptake or acceptance of preventive treatment for heart diseases. The study was based on previous research showing that the outcomes of preventive treatment for chronic diseases were partly based on the willingness of patients to accept the treatments. From the study, this link between preventive treatment for heart diseases and patients’ acceptance of such treatments was confirmed. From the sample population used in the study, only a third showed willingness to take the preventive medical treatment. The participants with previous personal experiences with heart diseases showed greater willingness to accept the treatment that those without such experiences. Additionally, the patient perceptions of the risks associated with using the preventive treatments affected their willingness to accept treatment. For instance, when the participants who had shown willingness to accept treatment were informed about the potential side effects, more than 50 per cent of them changed their initial decisions. The findings from this study emphasize the importance of informing patients on the risks associated with preventive treatments for heart diseases to alleviate misconceptions. Do, A., Irvin, M, Lynch, A, Claas, S, Boerwinkle, E, Davis, B, Ford, C, Eckfeldt, J, Tiwari, H, Limdi, N., & Arnett, D. 2014, The effects of angiotensinogen gene polymorphisms on cardiovascular disease outcomes during antihypertensive treatment in the GenHAT study, Frontiers In Pharmacology,vol. 5, pp. 1-8. Do et al., (2014) examined the effect of using antihypertensive drugs in the treatment of hypertension and related risks of developing CVD including heart failure and coronary heart disease. The study used two antihypertensive drugs including ACE and diuretics, which regulate the conversion salt-water balance in the RAAS. After administering these two classes of antihypertensive drugs to a sample population of individuals with high risk of hypertension, the researchers established that there were significant differences in the CVD risk levels between the African-American and Caucasian participants. This was associated with the racial differences in terms of alleles where African-Americans with minor allele of rs1122576 showed higher risk of coronary heart disease when using particular antihypertensive drugs as compared to others. The main implication from the study is the potential of personalizing antihypertensive treatment to ensure better outcomes with regard to CVD mortality and morbidity. This is based on the finding that the patient’s AGT could determine the effectiveness of different antihypertensive drugs. Keene, D., Price, C., Shun-Shin, M., J., & Francis, D., P. 2014, ‘Effect of cardiovascular risk of high density lipoprotein targeted drug treatments niacin, fibrates, and CETP inhibitors: Meta-analysis of randomized controlled trials including 117 411 patients’, BMJ, vol. 349, p. g4379. Keene et al., (2014) conducted a meta-analysis study with the main objective of exploring the effects of three drug interventions, including, CETP, fibrates, and niacin, on mortality and morbidity of CVD. The three drug interventions are widely used to increase the levels of high density lipoprotein, which has been known to reduce cardiovascular mortality and morbidity. The meta-analysis focused on pre-statin era as well as the current ere of statin use in treatment of CVD. With regard to the pre-statin era, the study established that fibrates and niacin were partly effective in reducing stroke and myocardial infraction. However, with the current widespread use of statins, these effects have not been seen. This suggests that the use of the three drugs interventions is not effective in treating or reducing CVD. The main motivation for the use of the three drugs has been that they increase the levels of high density lipoprotein. However, this study suggests that this assumption that the effect of niacin, CETP, and fibrates to increase levels of high density lipoproteins would translate to actual treatment of CVD is unfounded. Kobayashi, T., Saji, T., Otani, T., Takeuchi, K., Nakamura, T., Arakawa, H., Kato, T., Hara, T., Hamaoka, K., Ogawa, S., Miura, M., Nomura, Y., Fuse, S., Ichida, F., Seki, M., Fukazawa, R., Ogawa, C., Furuno, K., Tokunaga, H., Takatsuki, S., Hara, S. & Morikawa, A. 2012, ‘Efficacy of immunoglobulin plus prednisolone for prevention of coronary artery abnormalities in severe Kawasaki disease (RAISE study): a randomised, open-label, blinded-endpoints trial’, The Lancet, vol. 379, no. 9826, pp. 1613-20. Kobayashi et al., (2012) conducted a study to determine the potential advantages of using a combination of two treatments, intravenous immunoglobulin and prednisolone, instead of using only one, intravenous immunoglobulin. The study was based on findings from previous research that showed patients suffering from Kawasaki disease were predisposed to a higher risk of developing coronary artery abnormalities, fever, and CVD if they continued to use intravenous immunoglobulin and aspirin for long. The findings from the study showed that incidents of coronary artery abnormalities among patients using a combination of intravenous immunoglobulin and prednisolone were low. However, for the first batch of patients who were given intravenous immunoglobulin alone, the risks were high and the study had to be stopped for this batch. However, for the other batch using the combination of the two therapies, the findings showed the risk of developing coronary artery abnormalities and heart problems were low. The implication from this study is that treatment of Kawasaki disease, which is a major cause of coronary artery problems, should use a combined regimen of the normal immunoglobulin and aspirin as well as prednisolone. Kohli, P., Desai, N., R., Giugliano, R., P., Kim, J., B., Somaratne, R., Huang, F., Knusel, B., McDonald, S., Abrahamsen, T., Wasserman, S., M., Scott, R., & Sabatine, M., S. 2012, ‘Design and rationale of the LAPLACE-TIMI57 trial: A phase II, double-blind, placebo-controlled study of the efficacy and tolerability of a monoclonal antibody inhibitor of PCSK9 in subjects with hypercholesterolemia on background statin therapy’, Clinical Cardiology, vol. 35, no. 7, pp. 385-391. Kohli et al. (2012) conducted a study to evaluate the efficacy, tolerability, and safety of AMG 145 therapy when used together with statin therapy in patients with hypercholesterolemia. The study’s primary objective was to evaluate the effect of AMG 145 therapy administered for a period of 12 weeks based on the percentage change in subjects’ LDL-C levels. Secondary objectives included evaluating tolerability and safety of the treatment, effects of AMG 145 on various lipid parameters, and the pharmacokinetics characterization of AMG 145. Preliminary findings from the study indicated that AMG 145 inhibited the interaction between LDL-C receptor and PCSK9, which is indicative of the effectiveness of AMG 145 in the treatment of hypercholesterolemia. The AMG 145, which is a human monoclonal antibody, provides a potential treatment for CVD including hypercholesterolemia either as used alone or in addition to other CVD therapies including statin therapy. Finally, the study findings provide insights into the dose administration of AMG 145 for effective and safe treatment of CVD. Mc Namara, K, P, George, J, O’Reilly, S, L, Jackson, S, L, Peterson, G, M, Howarth, H. et al. 2010, ‘Engaging community pharmacists in the primary prevention of cardiovascular disease: Protocol for the pharmacist assessment of adherence, risk and treatment in cardiovascular disease (PAART CVD) pilot study. BMC Health Services Research, vol. 10, no. 1, p. 264. This pilot study seeks to examine the effectiveness of the involvement of community pharmacists in the primary prevention of cardiovascular diseases through management of risk factors. Mc Namara et al. (2010) use a longitudinal study covering a period of six months and a sample of 100 patients aged between 50 and 74 years. This sample population has no history of cardiovascular disease. The pilot study is inspired by the existence of previous studies showing that intervention of community pharmacists in managing CVD risk factors have been clinically effective. Through the pilot study, the researchers hope to come up with a report that will highlight their main findings. Specifically, the report findings will focus on the average changes in the patients’ overall 5-year risk of CVD, which will be based on Framingham-based CVD risk score used in New Zealand. The secondary outcomes from the study will focus on changes in patient health behaviour, medicine adherence, and modifiable CVD risk factors.When completed, the pilot study hopes to justify the primary intervention of community pharmacists as an effective treatment strategy for CVD. Mills, E. J., Wu, P., Chong, G., Ghement, I., Singh, S., Akl, E. A., ... & Briel, M. 2010, ‘Efficacy and safety of statin treatment for cardiovascular disease: A network meta-analysis of 170 255 patients from 76 randomized trials’, Qjm: An International Journal of Medicine, vol. 104, no. 2, pp. 109-124. Mills et al., (2010) conducted a comprehensive and in-depth study based on a review of 76 RCTs that had been conducted previously. The main purpose of the study was to establish clinical outcomes for the use of statins in the treatment of CVD. The study was based on the wide usage of statins in treatment of various CVD. From the analysis, Mills et al., (2010) established that statin therapy was effective in the treatment of CVD and reduction of all-cause mortality. The findings also showed that statins were effective in treatment of fatal and non-fatal myocardial infarction as well as stroke. These findings imply that the widely use statin treatment for various CVD is effective. With regard to the health risks associated with using statins for cardiovascular treatment, the meta-analysis showed limited clinical risks. However, biochemical profiles were found to have some effect of the risks of statin use. For instance, statins were found to increase diabetes incidents in some RCTs. The study also examined the relative effects of different statins including generic versions and brand-label versions. The various types of statins were found to have the same therapeutic effects. The findings from this meta-analysis support the use of statins for treatment of CVD. Nicholls, S. J., Ballantyne, C. M., Barter, P. J., Chapman, M. J., Erbel, R. M., Libby, P., ... & Nissen, S. E. 2011, ‘Effect of two intensive statin regimens on progression of coronary disease’, New England Journal of Medicine, vol. 365, no. 22, pp. 2078-2087. Nicholls et al., (2011) examines the use of intensive statin regimens in the regression of coronary disease. The study used two statin regimes including atorvastatin and rosuvastatin on a sample of 1039 coronary disease patients. After therapy lasting for 104 weeks, the findings from the study showed that both statin regimes were effective in regression of PAV. However, the atorvastatin regime achieved higher levels of LDL cholesterol and HDL lipoprotein than rosuvastatin regime. With regard to the side effects of using the two statin regimes, the study established that they were low. Some of the identified adverse effects included increase in levels of liver enzyme, creatine kinase, and alanine amino-transferase levels. The main implication from the study is that intensive use of statins can be effective in secondary treatment of coronary disease. The adverse effects from the use of statins are relatively low compared to the positive outcomes, which support the use of these drugs for treating CVD. Senesael, E., Borgermans, L., Van De Vijver, E., & Devroey, D. 2013, ‘Effectiveness of a quality improvement intervention targeting cardiovascular risk factors: Are patients responsive to information and encouragement by mail or post?’Vascular Health and Risk Management, vol. 9, pp. 13-20. Senesael et al., (2013) conducted a study to determine the effectiveness of using regular encouragement as a treatment approach to help people with high CVD risk manage their risk factors effectively and hence enhance treatment outcomes. The study focused on several outcomes associated with CVD risk factors including blood pressure, BMI, WC, smoking status, and weight.The study was based on the existing evidence on effectiveness of treatment of CVD risk factors in terms of mortality and morbidity. The findings from the study provided mixed outcomes. There was significant improvement in the subjects’ diastolic and systolic blood pressure. This finding suggests that the regular motivation of individuals with CVD high risk factors by providing them with relevant information is effective in enabling them to follow their treatment regime. However, there were no significant improvements in the other factors including weight, BMI, smoking status, and WC. The implication from the mixed findings to the motivation of CVD at-risk individuals or those with CVD is that the approach should be more behaviourally motivation to create the necessary self-esteem, self-efficacy, and self-management among the CVD patients. Conclusion In conclusion, the 10 research papers present various findings and insights regarding various advances in the treatment for CVD. One of the main findings is the potential of various treatments including preventive strategies and drugs such as statins in the treatment of CVD. Another major insight from the research papers is the factors that hinder the proper application and acceptance of treatment options for CVD including preconceptions about the risk factors of the various treatment options. Moreover, some of the research papers show the effectiveness of using mixed therapy approaches to enhance treatment outcomes for CVD. Finally, the research papers provide insights into the gaps and limitations that still exist in the treatment of CVD. All these insights are important for advances in biotechnology and molecular biology for the treatment of CVD. References Banegas, J. R., López-García, E., Dallongeville, J., Guallar, E., Halcox, J. P., Borghi, C., ... & Rodríguez-Artalejo, F. 2011, ‘Achievement of treatment goals for primary prevention of cardiovascular disease in clinical practice across Europe: The EURIKA study’, European heart journal, vol. 32, no. 17, pp. 2143-2152. Bo, N., J., Ejg, J., D., Dorte, G., Lind, B., B., & Veldt, L., P. 2014, ‘Determinants for acceptance of preventive treatment against heart disease – a web-based population survey’, BMC Public Health, vol. 14, no. 1, p. 783. Do, A., Irvin, M, Lynch, A, Claas, S, Boerwinkle, E, Davis, B, Ford, C, Eckfeldt, J, Tiwari, H, Limdi, N., & Arnett, D. 2014, The effects of angiotensinogen gene polymorphisms on cardiovascular disease outcomes during antihypertensive treatment in the GenHAT study, Frontiers In Pharmacology, vol. 5, pp. 1-8. Huffman, M, & Bhatnagar, D 2012, Novel treatments for cardiovascular disease prevention, Cardiovascular Therapeutics, vol. 30, no. 5, pp. 257-263. Keene, D., Price, C., Shun-Shin, M., J., & Francis, D., P. 2014, ‘Effect of cardiovascular risk of high density lipoprotein targeted drug treatments niacin, fibrates, and CETP inhibitors: Meta-analysis of randomized controlled trials including 117 411 patients’, BMJ, vol. 349, p. g4379. Kobayashi, T., Saji, T., Otani, T., Takeuchi, K., Nakamura, T., Arakawa, H., Kato, T., Hara, T., Hamaoka, K., Ogawa, S., Miura, M., Nomura, Y., Fuse, S., Ichida, F., Seki, M., Fukazawa, R., Ogawa, C., Furuno, K., Tokunaga, H., Takatsuki, S., Hara, S. & Morikawa, A. 2012, ‘Efficacy of immunoglobulin plus prednisolone for prevention of coronary artery abnormalities in severe Kawasaki disease (RAISE study): a randomised, open-label, blinded-endpoints trial’, The Lancet, vol. 379, no. 9826, pp. 1613-20. Kohli, P., Desai, N., R., Giugliano, R., P., Kim, J., B., Somaratne, R., Huang, F., Knusel, B., McDonald, S., Abrahamsen, T., Wasserman, S., M., Scott, R., & Sabatine, M., S. 2012, ‘Design and rationale of the LAPLACE-TIMI57 trial: A phase II, double-blind, placebo-controlled study of the efficacy and tolerability of a monoclonal antibody inhibitor of PCSK9 in subjects with hypercholesterolemia on background statin therapy’, Clinical Cardiology, vol. 35, no. 7, pp. 385-391. Mc Namara, K, P, George, J, O’Reilly, S, L, Jackson, S, L, Peterson, G, M, Howarth, H. et al. 2010, ‘Engaging community pharmacists in the primary prevention of cardiovascular disease: Protocol for the pharmacist assessment of adherence, risk and treatment in cardiovascular disease (PAART CVD) pilot study. BMC Health Services Research, vol. 10, no. 1, p. 264. Mills, E. J., Wu, P., Chong, G., Ghement, I., Singh, S., Akl, E. A., ... & Briel, M. 2010, ‘Efficacy and safety of statin treatment for cardiovascular disease: A network meta-analysis of 170 255 patients from 76 randomized trials’, Qjm: An International Journal of Medicine, vol. 104, no. 2, pp. 109-124. Nicholls, S. J., Ballantyne, C. M., Barter, P. J., Chapman, M. J., Erbel, R. M., Libby, P., ... & Nissen, S. E. 2011, ‘Effect of two intensive statin regimens on progression of coronary disease’, New England Journal of Medicine, vol. 365, no. 22, pp. 2078-2087. Senesael, E., Borgermans, L., Van De Vijver, E., & Devroey, D. 2013, ‘Effectiveness of a quality improvement intervention targeting cardiovascular risk factors: Are patients responsive to information and encouragement by mail or post?’Vascular Health and Risk Management, vol. 9, pp. 13-20. Van Camp, G. 2014, ‘Cardiovascular disease prevention’, Acta Clinica Belgica, vol. 69, no. 6, pp. 407-11. Read More