Efeitos da suplementação de ácidos graxos poliinsaturados ω-3 em pacientes com doenças cardiovasculares
Supplementation effects of fatty acids polyunsaturated ω-3 in patients with cardiovascular diseases
Iolanda Karla Santana dos Santos, Renata Cristina Campos Gonçalves
Resumo
Introdução: As doenças cardiovasculares (DCV) correspondem a um grupo de afecções que incluem a doença arterial coronariana, aterosclerose, hipertensão arterial sistêmica, doença cardíaca isquêmica, doença vascular periférica e insuficiência cardíaca. Os potenciais benefícios dos ácidos graxos poli-insaturados ω-3 (AGPI ω-3) são efeitos antitrombótico, anti-inflamatório e antiarrítmico; melhora do perfil cardíaco, da frequência cardíaca e da função endotelial, e redução da pressão arterial e do estresse oxidativo. Objetivo: Avaliar os potenciais benefícios da suplementação de AGPI ω-3 em pacientes com DCV. Método: Levantamento da literatura na base de dados eletrônica PubMed, compreendendo o período de maio de 2010 a maio de 2015. Nessa base de dados foram utilizados os descritores em inglês: “omega 3” combinado com “cardiovascular disease”. Resultados: Foram analisados 19 artigos científicos, sendo que 42,1% dos estudos incluídos foram publicados no ano de 2011. Considerando o tipo de desenho do estudo, 57,9% dos artigos eram randomizados, multicêntricos, placebo-controlados e duplocego. Os resultados compilados nesse trabalho foram divergentes, visto que sete publicações não encontraram nenhuma melhoria nos desfechos analisados; entre as demais publicações, os resultados observados foram distintos. Benefícios foram encontrados para melhoria dos parâmetros cardíacos, na coagulação sanguínea, concentração de triglicerídeos, concentração de leptina e adiponectina, melhoria de sintomas depressivos e redução da concentração plasmática de citocinas inflamatórias. Conclusão: A dificuldade de se observar os benefícios dos AGPI ω-3 se deve às melhorias do tratamento medicamentoso nas DCV.
Palavras-chave
Abstract
Introduction: Cardiovascular diseases (CVD) represent a group of diseases including coronary artery disease, atherosclerosis, hypertension, ischemic heart disease, peripheral vascular disease and heart failure. The potential benefits of ω-3 polyunsaturated fatty acids (ω-3 PUFA) are antithrombotic, anti-inflammatory and antiarrhythmic effects; improvement of cardiac profile, heart rate and endothelial function; and lowering blood pressure and oxidative stress. Objective: To assess the potential benefits of ω-3 PUFA supplementation in patients with CVD. Methods: Literature review on electronic database PubMed, covering the period from 2010 May to 2015 May. In this database, the descriptors in English “omega 3” combined with “cardiovascular disease” were used. Results: Nineteen scientific papers were analyzed, and 42.1% of the included studies were published in 2011. Considering the type of study design, 57.9% of the papers were randomized, multicenter, placebo-controlled and double-blind. The results compiled in this study were divergent, once seven publications didn’t find improvement in outcome measures; among the other publications the results obtained were distinct. Benefits have been found to improve cardiac parameters, blood coagulation, triglycerides concentration, leptin and adiponectin concentrations, improvement of depressive symptoms and decreased plasma concentration of inflammatory cytokines. Conclusion: The difficulty to observe the benefits of ω-3 PUFA is due to the improvement of drug treatment in CVD.
Keywords
Referências
1. Raymond, JL, Couch SC. Tratamento nutricional clínico da doença cardiovascular. In: Mahan LK, Escott-Stump S, Raymond JL, eds. Krause: alimentos, nutrição e dietoterapia. Rio de Janeiro: Elsevier; 2012.
2. Galan P, Kesse-Guyot E, Czernichow S, Briancon S, Blacher J, Hercberg S; SU.FOL.OM3 Collaborative Group. Effects of B vitamins and omega 3 fatty acids on cardiovascular diseases: a randomised placebo controlled trial. BMJ. 2010;341:c6273.
3. Macchia A, Grancelli H, Varini S, Nul D, Laffaye N, Mariani J, et al.; GESICA Investigators. Omega-3 fatty acids for the prevention of recurrent symptomatic atrial fibrillation: results of the FORWARD (Randomized Trial to Assess Efficacy of PUFA for the Maintenance of Sinus Rhythm in Persistent Atrial Fibrillation) trial. J Am Coll Cardiol. 2013;61(4):463-8.
4. Mizia-Stec K, Mizia M, Haberka M, Lasota B, Gieszczyk-Strózik K, Chmiel A, et al. Omega-3 polyunsaturated fatty acids do not influence the efficacy of dual antiplatelet therapy in stable angina pectoris patients after percutaneous coronary intervention. Cardiol J. 2013;20(5):478-85.
5. Mostowik M, Gajos G, Zalewski J, Nessler J, Undas A. Omega-3 polyunsaturated fatty acids increase plasma adiponectin to leptin ratio in stable coronary artery disease. Cardiovasc Drugs Ther. 2013;27(4):289-95.
6. Andreeva VA, Kesse-Guyot E, Barberger-Gateau P, Fezeu L, Hercberg S, Galan P. Cognitive function after supplementation with B vitamins and long-chain omega-3 fatty acids: ancillary findings from the SU.FOL.OM3 randomized trial. Am J Clin Nutr. 2011;94(1):278-86.
7. Haberka M, Mizia-Stec K, Mizia M, Gieszczyk K, Chmiel A, Sitnik-Warchulska K, et al. Effects of Omega-3 polyunsaturated fatty acids on depressive symptoms, anxiety and emotional state in patients with acute myocardial infarction. Pharmacol Rep. 2013;65(1):59-68.
8. Nodari S, Triggiani M, Campia U, Manerba A, Milesi G, Cesana BM, et al. Effects of Omega-3 polyunsaturated fatty acids on left ventricular function and functional capacity in patients with dilated cardiomyopathy. J Am Coll Cardiol. 2011;57(7):870-9.
9. Bianconi L, Calò L, Mennuni M, Santini L, Morosetti P, Azzolini P, et al. Omega-3 polyunsaturated fatty acids for the prevention of arrhythmia recurrence after electrical cardioversion of chronic persistent atrial fibrillation: a randomized, double-blind, multicentre study. Europace. 2011;13(2):174-81.
10. Carney RM, Freedland KE, Stein PK, Steinmeyer BC, Harris WS, Rubin EH, et al. Effect of omega-3 fatty acids on heart rate variability in depressed patients with coronary heart disease. Psychosom Med. 2010;72(8):748-54.
11. Eussen SR, Geleijnse JM, Giltay EJ, Rompelberg CJ, Klungel OH, Kromhout D. Effects of n-3 fatty acids on major cardiovascular events in statin users and non-users with a history of myocardial infarction. Eur Heart J. 2012;33(13):1582-8.
12. Gajos G, Zalewski J, Rostoff P, Nessler J, Piwowarska W, Undas A. Reduced thrombin formation and altered fibrin clot properties induced by polyunsaturated omega-3 fatty acids on top of dual antiplatelet therapy in patients undergoing percutaneous coronary intervention (OMEGA-PCI clot). Arterioscler Thromb Vasc Biol. 2011;31(7):1696-702.
13. Giltay EJ, Geleijnse JM, Kromhout D. Effects of Omega-3 fatty acids on depressive symptoms and dispositional optimism after myocardial infarction. Am J Clin Nutr. 2011;94(6):1442-50. Santos IKS & Gonçalves RCC
14. Kromhout D, Geleijnse JM, de Goede J, Oude Griep LM, Mulder BJ, de Boer MJ, et al. Omega-3 fatty acids, ventricular arrhythmia-related events, and fatal myocardial infarction in postmyocardial infarction patients with diabetes. Diabetes Care. 2011;34(12):2515-20.
15. Kromhout D, Giltay EJ, Geleijnse JM; Alpha Omega Trial Group. Omega-3 fatty acids and cardiovascular events after myocardial infarction. N Engl J Med. 2010;363(21):2015-26.
16. Mozaffarian D, Marchioli R, Macchia A, Silletta MG, Ferrazzi P, Gardner TJ, et al.; OPERA Investigators. Fish oil and postoperative atrial fibrillation: the Omega-3 Fatty Acids for Prevention of Post-operative Atrial Fibrillation (OPERA) randomized trial. JAMA. 2012;308(19):2001-11.
17. Nodari S, Triggiani M, Campia U, Manerba A, Milesi G, Cesana BM, et al. Omega-3 polyunsaturated fatty acids in the prevention of atrial fibrillation recurrences after electrical cardioversion: a prospective, randomized study. Circulation. 2011;124(10):1100-6.
18. Ozaydın M, Erdoğan D, Tayyar S, Uysal BA, Doğan A, Içli A, et al. Omega-3 polyunsaturated fatty acids administration does not reduce the recurrence rates of atrial fibrillation and inflammation after electrical cardioversion: a prospective randomized study. Anadolu Kardiyol Derg. 2011;11(4):305-9.
19. Rauch B, Schiele R, Schneider S, Diller F, Victor N, Gohlke H, et al.; OMEGA Study Group. OMEGA, a randomized, placebocontrolled trial to test the effect of highly purified omega-3 fatty acids on top of modern guideline-adjusted therapy after myocardial infarction. Circulation. 2010;122(21):2152-9.
20. Wu JH, Marchioli R, Silletta MG, Macchia A, Song X, Siscovick DS, et al. Plasma phospholipid omega-3 fatty acids and incidence of postoperative atrial fibrillation in the OPERA trial. J Am Heart Assoc. 2013;2(5):e000397.
Submetido em:
15/05/2016
Aceito em:
29/07/2016
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