SÍNDROME METABÓLICA E DOENÇAS CARDIOVASCULARES: DO CONCEITO AO TRATAMENTO
DOI:
https://doi.org/10.63845/swbssf51Palavras-chave:
Síndrome metabólica. Doença cardiovascular. Estratificação de risco. Prevenção. Tratamento medicamentoso.Resumo
Nas últimas décadas, o entendimento dos mecanismos biológico e molecular da síndrome metabólica sofreu mudanças na melhor compreensão e reconhecimento precoce para prevenção e abordagens terapêuticas eficazes. Este artigo tem como objetivo rever os conceitos e os principais aspectos da fisiopatologia, fatores de risco cardiovasculares e tratamento das patologias que envolvem a síndrome metabólica e doenças cardiovasculares, analisando medidas necessárias a serem adotadas no dia a dia do cardiologista clínico, com base na epidemiologia cardiovascular, interpretando os riscos à luz dos escores de estratificação e, consequentemente, intervir sobre eles utilizando uma abordagem clínica adequada. Nessa revisão, são discutidos os conceitos e as implicações clínicas dos fatores de risco cardiovasculares e critérios diagnósticos e terapêuticos da Síndrome Metabólica.Referências
Monte, O, Lervolino, L, Abrahão, GCP. Cap. 18: Fatores de risco – aspectos práticos: Síndrome Metabólica e Diabetes. In: Timmerman, A, Bertolami, M, Ferreira, JF.M.: Manual de Cardiologia. Ed. Atheneu. São Pulo. Brasil, 2012: 129-136.
Paredes, S, Rocha, T, Mendes, D e cols. New approaches for improving cardiovascular risk assessment. Rev Port Cardiol. 2016; 35: 15-18. DOI: https://doi.org/10.1016/j.repc.2015.10.006
Rocha, E. Síndrome metabólica – uma entidade com indefinições mas que é útil identificar na prática clínica. Rev Port Cardiol. 2008; 27 (12): 1531-1537.
Executive Summary of The Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA. 2001;285(19):2486-97. DOI: https://doi.org/10.1001/jama.285.19.2486
Reaven, GM. The metabolic syndrome: time to get off the merry-go-round? (Review) J Intern Med 2011; 269: 127-136. DOI: https://doi.org/10.1111/j.1365-2796.2010.02325.x
Xavier, HT, Izar, MC, Faria Neto, JR e cols. V Diretriz Brasileira de Dislipidemias e Prevenção da Aterosclerose. Arq Bras Cardiol. 2013; 101 (supl.1): 1-22. DOI: https://doi.org/10.5935/abc.2013S010
VI Diretrizes Brasileiras de Hipertensão. Arq Bras Cardiol. 2010;95(1 Supl.1):1-51. DOI: https://doi.org/10.1590/S0066-782X2010001700001
Rask-Madsen, C, Kahn, CR. Tissue-specific signaling, metabolic syndrome and cardiovascular disease. Arterioscler Thromb Vasc Biol. 2012;32:2052-2059. DOI: https://doi.org/10.1161/ATVBAHA.111.241919
Moraes, NS, Souza, JAG, Miranda, RD. Hipertensão Arterial, diabetes mellitus e síndrome metabólica: do conceito à terapêutica. Rev Bras Hipertens. 2013; 20(3): 110-117.
Gualandro, DM, Azevedo, FR, Calderaro, D e cols. I Diretriz sobre aspectos específicos de Diabetes (tipo II) relacionados à Cardiologia. Arq Bras Cardiol. 2014; 102(5Supl.1):1-30. DOI: https://doi.org/10.5935/abc.2014S002
Fox CS, Pencina MJ, Wilson PW, Paynter NP, Vasan RS, D’Agostino RB Sr. Lifetime risk of cardiovascular disease among individuals with and without diabetes stratified by obesity status in the Framingham Heart Study. Diabetes Care.2008;31(8):1582-4. DOI: https://doi.org/10.2337/dc08-0025
D’Agostino RB, Vasan RS, Pencina MJ, Wolf PA, Cobain M, Massaro JM, et al. General cardiovascular risk profile for use in primary care: the Framingham Heart Study. Circulation. 2008;117(6):743-53. DOI: https://doi.org/10.1161/CIRCULATIONAHA.107.699579
Ridker PM, Buring JE, Rifai N, Cook NR. Development and validation of improved algorithms for the assessment of global cardiovascular risk in women: the Reynolds Risk Score. JAMA. 2007;297(6):611-9. DOI: https://doi.org/10.1001/jama.297.6.611
Ridker PM, Paynter NP, Rifai N, Gaziano JM, Cook NR. C-reactive protein and parental history improve global cardiovascular risk prediction: the Reynolds Risk Score for men. Circulation. 2008;118(22):2243-51. DOI: https://doi.org/10.1161/CIRCULATIONAHA.108.814251
Lloyd-Jones DM, Leip EP, Larson MG, D’Agostino RB, Beiser A, Wilson PW, et al. Prediction of lifetime risk for cardiovascular disease by risk factor burden at 50 years. Circulation. 2006;113(6):791-8. DOI: https://doi.org/10.1161/CIRCULATIONAHA.105.548206
Berry JD, Dyer A, Cai X, Garside DB, Ning H, Thomas A, et al. Lifetime risks of cardiovascular disease. N Engl J Med. 2012;366(4):321-9. DOI: https://doi.org/10.1056/NEJMoa1012848
Alberti KG, Eckel RH, Grundy SM, Zimmet PZ, Cleeman JI, Donato KA, et al. Harmonizing the Metabolic Syndrome. A Joint Interim Statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation. 2009;120(16):640-5. DOI: https://doi.org/10.1161/CIRCULATIONAHA.109.192644
Guimarães, FS, Sant Anna Junior, M, Carneiro, JRI e cols. Disfunção autonômica cardiovascular em pacientes com obesidade mórbida. Arq Bras Cardiol. 2015; 105 (6): 580-587.
Simão, AF, Precoma, DB, Andrade, JP E COLS. I Diretriz Brasileira de Prevenção Cardiovascular. Arq Bras Cardiol 2013; 101 (supl.2): 1-63.
Reiner Z, Catapano AL, De Backer G, Graham I, Taskinen MR, Wiklund O, et al; European Association for Cardiovascular Prevention Rehabilitation.ESC/EAS guidelines for the management of dyslipidaemias the Task Force for the Management of Dyslipidaemias of the European Society of Cardiology (ESC) and the European Atherosclerosis Society (EAS). Eur Heart J. 2011;32(14):1769-818. DOI: https://doi.org/10.1093/eurheartj/ehr158
Mosca L, Benjamin EJ, Berra K, Bezanson JL, Dolor RJ, Lloyd-Jones DM, et al. Effectiveness-based guidelines for the prevention of cardiovascular disease in women – 2010 update. A guideline from the American Heart Association. Circulation. 2011;123(22):1243-62. DOI: https://doi.org/10.1161/CIR.0b013e31820faaf8
Jansson, PA. Symposium: Insulinaction and endothelial dysfunction. 2007; Journal of Internal Medicine 262;173-183. DOI: https://doi.org/10.1111/j.1365-2796.2007.01830.x
Potenza, MA, Gagliardi, S, Nacci, C, Carratu, MR, Montagnani, M. Endothelial dysfunction in Diabetes: from mechanisms to therapeutic targets. Current Medicinal Chemistry 2009; 16: 94-112. DOI: https://doi.org/10.2174/092986709787002853
von Hafe, P. Dislipidemia e obesidade. Rev Fatores de risco 2015; 38: 92-97.
Hotamisligil, GS. Endoplasmic reticulum stress and the inflammatory basis of metabolic disease. (Review) Cell 2010; 140: 900-917. DOI: https://doi.org/10.1016/j.cell.2010.02.034
Hotamisligil GS. Inflammation and metabolic disorders. Nature. 2006;444(7121):860-7. DOI: https://doi.org/10.1038/nature05485
Fresno M, Alvarez R, Cuesta N. Toll-like receptors, inflammation, metabolism and obesity. Arch Physiol Biochem. 2011;117(3):151-64.304. DOI: https://doi.org/10.3109/13813455.2011.562514
Powell K. Obesity: the two faces of fat. Nature. 2007;447(7144):525-7.305. DOI: https://doi.org/10.1038/447525a
Thompson AK, Minihane AM, Williams CM. Trans fatty acids, insulin resistance and diabetes. Eur J Clin Nutr. 2011;65(5):553-64. DOI: https://doi.org/10.1038/ejcn.2010.240
Mansur, AP, Rocha, ABS, Leyton, V e cols. Fatores de risco para doença cardiovascular, síndrome metabólica e sonolência em motoristas de caminhão. Arq Bras Cardiol. 2015: 105 (6): 560-565.
Cortez-Dias, N, Martins, S, Belo, A , Fiuza, M. Comparação de diferentes definições de síndrome metabólica: implicações no risco de doença coronária e acidente vascular cerebral. Rev Port Cardiol. 2011; 30(2):139-169.
Benetos A, Thomas F, Pannier B, Bean K, Jego B, Guize L. All-cause and cardiovascular mortality using the different definitions of metabolic syndrome. Am J Cardiol 2008; 102(2):188-191. DOI: https://doi.org/10.1016/j.amjcard.2008.03.037
Gismondi,RA e cols. Estatina, inibidor da angiotensina e função do endotélio. Arq Bras Cardiol 2015; 105 (6): 597-605.
Santos RD, Gagliardi AC, Xavier HT, Magnoni CD, Cassani R, Lottenberg AM. I Diretriz sobre o consumo de gorduras e saúde cardiovascular. Arq Bras Cardiol.2013;100(1 Suppl 3):1-40. DOI: https://doi.org/10.5935/abc.2013S003
Preiss, D, Sattar, N. Lipids, lipid modifying agents and cardiovascular risk: a review of the evidence. Clinical Endocrinology. 2009;70:815-828. DOI: https://doi.org/10.1111/j.1365-2265.2008.03490.x
Tchernof A, Deprès JP. Pathophysiology of human visceral obesity: an update. Physiol Rev. 2013; 93:359-404. DOI: https://doi.org/10.1152/physrev.00033.2011
Weaver KL, Ivester P, Seeds M, Case LD, Arm JP, Chilton FH. Effect of dietary fatty acids on inflammatory gene expression in healthy humans. J Biol Chem. 2009;284(23):15400-7. DOI: https://doi.org/10.1074/jbc.M109.004861
Fonseca, FAH. Farmacocinética das estatinas. Arq Bras Cardiol. 2005; 85(supl.5):9-14. DOI: https://doi.org/10.1590/S0066-782X2005002400003
Davidson, MH, Toth, PP. Comparative effects of lipids lowering therapies. Prog CardiovascDis. 2004;47:73-104. DOI: https://doi.org/10.1016/j.pcad.2004.04.007
Costa, S, Couto, MR, Teixeira, AA, Sousa, T. Estatinas e estresse oxidativo na insuficiência cardíaca crônica. Rev Port Cardiol 2016; 35 (1): 41-57. DOI: https://doi.org/10.1016/j.repc.2015.09.006
Scultz, I. Tratamento das Dislipidemias – como e quando indicar a combinações de medicamentos hipolipemiantes. Arq Bras Endocrinol Metab. 2006;50:344-359. DOI: https://doi.org/10.1590/S0004-27302006000200021
Delbosc, S, Cristol, J-P, Descomps, B, Mimran, A, Jover, B. Simvastatin prevents Angiotensin II- induced cardiac alteration and Oxidative stress. Hypertension 2002; 40: 142-147. DOI: https://doi.org/10.1161/01.HYP.0000024348.87637.6F
Galicchio, CT, Castro, SH. Cap. 13: Farmacologia dos Hipolipemiantes. In: Ferreira, ME, Brunini, T. Farmacologia Cardiovascular. Ed. Rubio. Rio de Janeiro. Brasil, 2008: 257-284.
Cornier, MA e cols. The Metabolic Syndrome. Lancet, 2008;365:1415-1428. DOI: https://doi.org/10.1016/S0140-6736(05)66378-7
Grundy SM, Cleeman JI, Daniels SR et al. Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Circulation 2005; 112(17):2735-2752. DOI: https://doi.org/10.1161/CIRCULATIONAHA.105.169404
Nissen, SE, Nicholls, SJ, Sipahi, I e cols. Effect of very high-intensity statin therapy on regression of coronary atherosclerosis. The ASTEROID trial. JAMA. 2006;295:1556-1565. DOI: https://doi.org/10.1001/jama.295.13.jpc60002
Teegala SM, Willett WC, Mozaffarian D. Consumption and health effects of trans fatty acids: a review. J AOAC Int. 2009;92(5):1250-7. DOI: https://doi.org/10.1093/jaoac/92.5.1250
Crowley, SD, Coffman,TM. Recent advances involving the renin-angiotensin system. Exp Cell Res. 2012; 318(9):1049-1056. DOI: https://doi.org/10.1016/j.yexcr.2012.02.023
Chandran M, Phillips SA, Ciaraldi T, Henry RR. Adiponectin: more than just another fat cell hormone? Diabetes Care 2003; 26(8):2442-2450. DOI: https://doi.org/10.2337/diacare.26.8.2442
Petto, j, Santos, ACN, Motta, MT e cols. Adiponectina: caracterização, ação metabólica e cardiovascular. Int J Cardiovasc Sci. 2015; 28(5):424-432. DOI: https://doi.org/10.5935/2359-4802.20150062
Gami AS, Witt BJ, Howard DE et al. Metabolic syndrome and risk of incident cardiovascular events and death: a systematic review and meta-analysis of longitudinal studies. J Am Coll Cardiol 2007; 49(4):403-414. DOI: https://doi.org/10.1016/j.jacc.2006.09.032
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Este trabalho está licenciado sob uma licença Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
