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Clinical Pharmacy-2013 : Effects of direct renin inhibition on atherosclerotic biomarkers in patients with stable coronary artery disease and type 2 diabetes mellitus - Brian K. Irons - Texas Tech University Health Sciences Center Schools of Pharmacy and Medicine

Abstract

 To evaluate whether the direct renin inhibitor, aliskiren, has a more favorable effect compared to amlodipine on atherosclerotic biomarkers in patients with stable coronary artery disease and diabetes currently receiving standard secondary prevention therapy.  Methods: Thirty eight subjects were randomly assigned initially to either aliskiren (150 mg daily) or amlodipine (5 mg daily) for two weeks after which the dose of either medication was increased to its maximum daily dose for four additional weeks. Baseline and six week blood samples were analyzed for changes from baseline and between treatment groups for vascular and intracellular cell adhesion molecule (VCAM and ICAM), c-reactive protein (CRP), nitric oxide (NO), plasminogen activator inhibitor-1 (PAI1), 8-isoprostane, and thiobarbituric acid reactive substances (TBARS).  Results: Thirty one patients completed the study. More of the drop outs occurred in subjects receiving aliskiren. Systolic blood pressure decreased in both treatment arms with no differences between groups being noted. PAI-1, NO, and CRP concentrations increased in both groups from baseline but changes from baseline or between groups were not significant. VCAM, ICAM, TBARS, and isoprostane concentrations decreased in each treatment arm from baseline but these changes were not significant and no differences between groups were noted. Conclusions: Treatment with either aliskiren or amlodipine did not significantly alter surrogate biomarkers of atherosclerosis in patients with both diabetes and established cardiovascular disease already receiving appropriate secondary cardiovascular prevention therapy. The study is limited in its size and duration to see an effect. Type 2 diabetes is a long lasting illness that shields your body from utilizing insulin the manner in which it should. Individuals with type 2 diabetes are said to have insulin obstruction. Individuals who are moderately aged or more established are well on the way to get this sort of diabetes, so it used to be called grown-up beginning diabetes. Be that as it may, type 2 diabetes additionally influences children and youngsters, predominantly in view of youth weight. It's the most widely recognized sort of diabetes. There are around 29 million individuals in the U.S. with type 2. Another 84 million have prediabetes, which means their glucose (or blood glucose) is high yet not sufficiently high to be diabetes yet. In medication, a biomarker is a quantifiable marker of the seriousness or nearness of some malady state. All the more for the most part a biomarker is whatever can be utilized as a pointer of a specific infection state or some other physiological condition of a creature. A biomarker can be a substance that is brought into a living being as a way to look at organ work or different parts of wellbeing. For instance, rubidium chloride is utilized in isotopic marking to assess perfusion of heart muscle. It can likewise be a substance whose recognition demonstrates a specific sickness state, for instance, the nearness of a counter acting agent may show a contamination. All the more explicitly, a biomarker demonstrates an adjustment in articulation or condition of a protein that corresponds with the hazard or movement of a malady, or with the vulnerability of the sickness to a given treatment. Biomarkers can be trademark organic properties or atoms that can be recognized and estimated in parts of the body like the blood or tissue. They may demonstrate either typical or unhealthy procedures in the body. Biomarkers can be explicit cells, particles, or qualities, quality items, catalysts, or hormones. Complex organ capacities or general trademark changes in natural structures can likewise fill in as biomarkers. In spite of the fact that the term biomarker is moderately new, biomarkers have been utilized in pre-clinical research and clinical analysis for an impressive time. For instance, internal heat level is a notable biomarker for fever. Circulatory strain is utilized to decide the danger of stroke. It is likewise generally realized that cholesterol esteems are a biomarker and hazard pointer for coronary and vascular infection, and that C-responsive protein (CRP) is a marker for irritation. Biomarkers are valuable in various manners, including estimating the advancement of sickness, assessing the best remedial systems for a specific malignancy type, and building up long haul helplessness to disease or its recurrence. The parameter can be compound, physical or natural. In sub-atomic terms biomarker is "the subset of markers that may be found utilizing genomics, proteomics advancements or imaging innovations. Biomarkers assume significant jobs in therapeutic science. Biomarkers help in early analysis, malady counteraction, sedate objective distinguishing proof, tranquilize reaction and so on. A few biomarkers have been distinguished for some maladies, for example, serum LDL for cholesterol, pulse, and P53 gene and MMPs as tumor markers for disease. Type 2 diabetes (T2D), once in the past known as grown-up beginning diabetes, is a type of diabetes that is portrayed by high glucose, insulin obstruction, and relative absence of insulin. Common manifestations incorporate expanded thirst, visit pee, and unexplained weight loss. Symptoms may likewise incorporate expanded appetite, feeling tired, and injuries that don't heal. Often indications please slowly. Long-term confusions from high glucose incorporate coronary illness, strokes, diabetic retinopathy which can bring about visual impairment, kidney disappointment, and poor blood stream in the appendages which may prompt amputations. The abrupt beginning of hyperosmolar hyperglycemic state may happen; nonetheless, ketoacidosis is uncommon. Biography Brian K. Irons is an Associate Professor and Division Head-Ambulatory Care at the Texas Tech University Health Sciences Center School of Pharmacy. He has been on faculty there since 1999. He completed both a PGY-1 and PGY-2 residency after completing his BS and PharmD from the University of Wisconsin. Dr. Irons has over 35 publications most of which are in the area of management of type 2 diabetes mellitus. He is a Fellow with the American College of Clinical Pharmacy.   Brian.Irons@ttuhsc.edu

Brian K. Irons, Alex Trujillo, Charles F. Seifert, Jan S. Simoni, Susan Doctolero and Gary E. Meyerrose 

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