Efeitos da perda ponderal sobre função vascular, sistema nervoso autonômico e biomarcadores metabólicos em obesos com saúde cardiovascular moderada e baixa

Abstract

According to the American Heart Association, most cardiovascular events can be prevented through adherence to eight behavior (smoking, physical activity, diet, and sleep health) and health factors (Body Mass Index (BMI), non-HDL-cholesterol, blood pressure and glycated hemoglobin), reflecting the classification of cardiovascular health (CVH) as high, moderate and low. This study aimed to evaluate the effects of weight loss on vascular function, sympathetic tone, metabolic and inflammatory biomarkers in obese subjects with moderate and low CVH. A prospective intervention study was conducted with patients of both sexes, aged between 40 and 70 years, BMI ≥30 and <40kg/m², instructed to follow a low-calorie diet (800kcal/day reduction) for 16 weeks. At baseline, after eight and 16 weeks of nutritional intervention, patients underwent assessment of central hemodynamics and arterial stiffness by oscillometry (Mobil-O-Graph®), autonomic system by heart rate variability (Polar® RS800), and microvasculature reactivity using the laser system contrast image (LSCI,Pericam®). The sleep study was performed at baseline and after 16 weeks of intervention with a home device (Watch-PAT 200®), as well as brachial artery flow-mediated dilation (FMD). The intima-media thickness was evaluated only in the baseline period from carotid ultrasound. Eighty-two patients were included, 75% female, with a mean age of 50 for women and 55 years for men, divided into two groups based on the CVH classification at baseline: moderate CVH (CVH score ≥ 50 ≤ 79 points, n=47); and low CVH (CVH score ≤ 49, n=35). The CVH score was calculated from the average score of the eight metrics. At baseline, peripheral (119±10 vs 125±15 mmHg, p=0.048) and central (111±10 vs 118±15 mmHg; p=0.016) systolic pressures were significantly higher in the low CVH group, which also had lower FMD (9.24±5.41 vs 6.79±4.74%, p=0.043) compared to the moderate CVH group. After eight weeks of nutritional intervention, only the low CVH group showed a decrease in peripheral (131±15 vs 122±17 mmHg, p<0.001) and central (119±15 vs 113±12 mmHg, p=0.049) pressures and increased cutaneous vascular conductance after reactive hyperemia (0.99±0.28 vs 1.08±0.28 UAP/mmHg, p=0.039). The moderate CVH group had an increase in the RR interval (933±130 vs 994±131 bpm, p=0.006) in the same intervention period. After 16 weeks of intervention, the moderate CVH group, with a 4.1% weight loss, decreased the Framingham risk score (7.8±7.6 vs 7.0±6.8%, p=0.024), cholesterol/HDL-c ratio (4.0±0.9 vs 3.8±0.9, p=0.030), and atherogenic index of plasma (0.01±0.22 vs -0.08±0.20, p=0.004). The low CVH group, with a 5.1% weight loss, showed a decrease in vascular age (62±13 vs 58±14 years, p=0.023), insulin (20±11 vs 14±9 mcU/ml, p=0.002) and HOMA-IR (4.4±2.4 vs 3.1±2.0, p=0.002). Both groups significantly reduced C-reactive protein (-0.18 vs -0.25 mg/dl). In conclusion, the greatest benefits of the nutritional intervention occurred in the low cardiovascular health group, which showed improvement in insulin resistance and a reduction in peripheral and central blood pressure, with improvement in endothelial function as early as 8 weeks. The group with moderate cardiovascular health required a longer period of nutritional intervention to show vascular and blood pressure benefits, with an improvement in the lipid profile