Efeitos do ácido graxo ômega-3 e do ciprofibrato sobre a função endotelial e a rigidez arterial em pacientes hipertensos com hipertrigliceridemia: influência do gênero e do risco cardiovascular

• Autor(a) principal: Casanova, Marcela de Abreu
• Data de Publicação: 2016
• Tipo de documento: Tese
• Idioma: por
• Título da fonte: Biblioteca Digital de Teses e Dissertações da UERJ
• Texto Completo: http://www.bdtd.uerj.br/handle/1/8516
• topic: Hypertension; Hypertriglyceridemia; Gender difference; Endothelial function; Arterial stiffness; Cardiovascular risk; Omega-3 fatty acids; Ciprofibrate; Hipertensão; Hipertrigliceridemia; Diferença de gêneros; Função endotelial; Rigidez arterial; Risco cardiovascular; Ácidos graxos ômega-3; Ciprofibrato.; Hipertensão; Ácidos graxos Omega 3; Endotélio; Hipertrigliceridemia; Rigidez vascular; CNPQ::CIENCIAS DA SAUDE::NUTRICAO

Hypertriglyceridemia has been associated with increased cardiovascular (CV) risk. The impact of gender on lipid profile and the progression of atherosclerosis require further scientific evidence. The objective of this study was to evaluate the influence of gender and CV risk on the effects of omega-3 and ciprofibrate in endothelial function and arterial stiffness in hypertensive patients with hypertriglyceridemia. Thirty nondiabetic hypertensive patients with triglycerides (TG) between 150&#42999;499mg/dl were selected for a prospective, crossover, randomized study receiving treatment with 1800mg/day of omega-3 fatty acids or 100mg/day ciprofibrate for 12 weeks with a washout period of 8 weeks. We evaluated blood pressure (BP), estimated coronary artery disease (CAD) risk, reactive hyperemia index (RHI), flow-mediated dilatation (FMD) of brachial artery, carotid-femoral pulse wave velocity (cf-PWV) and aortic pressures. The average age was 54 years (40-65 years-old). The main results showed that both treatments were effective in reducing TG levels (reduction of 39% in the treatment with ciprofibrate and 21% in the treatment with omega-3). However, the decrease of TG levels was higher among men (-90mg/dl, p&#8804;0.001) for both treatment while only treatment with ciprofibrate lowered TG levels in women (-100mg/dl, p&#8804;0.001). Peripheral systolic BP (144 to 133mmHg vs 129 to 123mmHg), total cholesterol (214 to 199 mg/dl vs 230 to 193mg/dl), TG/HDL ratio (7.1 to 4.1 vs 7.0 to 4.2) and CAD risk (15 to 11% vs 6 to 4%) were significantly reduced after treatment with omega-3 in men and after treatment with ciprofibrate in women, respectively. There was also a greater reduction in cf-PWV (10.3 to 9.4m/s, p<0.05) and systolic aortic pressure (131 to 123mmHg, p<0.05) only in men treated with omega-3 while women treated with ciprofibrate showed an increase in RHI (1.8 to 2.3 units, p<0.05) and HDL-C (39 to 44mg/dl, p<0.05). In subjects grouped by CV risk, high-risk patients (&#8805;7.5%) showed reduced cf-PWV (10.4 to 9.4m/s, p<0.05) and FMD was increased (11.1 to 13.5%, p<0.05) by omega-3. Lower peripheral BP levels (131±84 to 125±79mmHg, p<0.05), total cholesterol (204 to 179mg/dl, p<0.05) and systolic aortic pressure (124 to 118mmHg, p<0.05) were observed at the end of the intervention with ciprofibrate in low-risk patients (<7.5%). There was also in these patient a significant increase in FMD with therapy with omega-3 (10.1 to 13.5%) and ciprofibrate (8.7 to 14.0%). In conclusion, the decrease of TG levels in women occurred only with ciprofibrate treatment and it was associated to an improvement in endothelial function while omega-3 resulted in beneficial effects on arterial stiffness in men, suggesting gender differences in the treatment of hypertriglyceridemia. Furthermore, the use of omega-3 improved arterial stiffness and endothelial function in high-risk patients, pointing out the beneficial effect of this therapy on vascular aging in this population.