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BACKGROUND: An individual's dietary pattern contributes in different ways to the prevention and control of recurrent cardiovascular events. However, the quality of the diet is influenced by several factors. The present study aimed to evaluate the quality of the diet of individuals with cardiovascular diseases and determine whether there is an association between sociodemographic and lifestyle factors. METHODS: This is a cross-sectional study carried out with individuals with atherosclerosis (coronary artery disease, cerebrovascular disease or peripheral arterial disease) recruited from 35 reference centres for the treatment of cardiovascular disease in Brazil. Diet quality was assessed according to the Modified Alternative Healthy Eating Index (mAHEI) and stratified into tertiles. For comparing two groups, the Mann-Whitney or Pearson's chi-squared tests were used. However, for comparing three or more groups, analysis of variance or Kruskal-Wallis was used. For the confounding analysis, a multinomial regression model was used. p < 0.05 was considered statistically significant. RESULTS: In total, 2360 individuals were evaluated: 58.5% male and 64.2% elderly. The median (interquartile range [IQR]) of the mAHEI was 24.0 (20.0-30.0), ranging from 0.4 to 56.0 points. When comparing the odds ratios (ORs) for the low (first tertile) and medium (second tertile) diet quality groups with the high-quality group (third tertile), it was observed that there was an association between diet quality with a family income of 1.885 (95% confidence intervals [CI] = 1.302-2.729) and 1.566 (95% CI = 1.097-2.235), as well as physical activity of 1.391 (95% CI = 1.107-1.749) and 1.346 (95% CI = 1.086-1.667), respectively. In addition, associations were observed between diet quality and region of residence. CONCLUSIONS: A low-quality diet was associated with family income, sedentarism and geographical area. These data are extremely relevant to assist in coping with cardiovascular disease because they enable an assessment of the distribution of these factors in different regions of the country.
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Doenças Cardiovasculares , Humanos , Masculino , Idoso , Feminino , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/prevenção & controle , Brasil , Estudos Transversais , Dieta , Dieta SaudávelRESUMO
BACKGROUND: An individual's dietary pattern contributes in different ways to the prevention and control of recurrent cardiovascular events. However, the quality of the diet is influenced by several factors. The present study aimed to evaluate the quality of the diet of individuals with cardiovascular diseases and determine whether there is an association between sociodemographic and lifestyle factors. METHODS: This is a cross-sectional study carried out with individuals with atherosclerosis (coronary artery disease, cerebrovascular disease or peripheral arterial disease) recruited from 35 reference centres for the treatment of cardiovascular disease in Brazil. Diet quality was assessed according to the Modified Alternative Healthy Eating Index (mAHEI) and stratified into tertiles. For comparing two groups, the Mann-Whitney or Pearson's chi-squared tests were used. However, for comparing three or more groups, analysis of variance or Kruskal-Wallis was used. For the confounding analysis, a multinomial regression model was used. p < 0.05 was considered statistically significant. RESULTS: In total, 2360 individuals were evaluated: 58.5% male and 64.2% elderly. The median (interquartile range [IQR]) of the mAHEI was 24.0 (20.0-30.0), ranging from 0.4 to 56.0 points. When comparing the odds ratios (ORs) for the low (first tertile) and medium (second tertile) diet quality groups with the high-quality group (third tertile), it was observed that there was an association between diet quality with a family income of 1.885 (95% confidence intervals [CI] = 1.302-2.729) and 1.566 (95% CI = 1.097-2.235), as well as physical activity of 1.391 (95% CI = 1.107-1.749) and 1.346 (95% CI = 1.086-1.667), respectively. In addition, associations were observed between diet quality and region of residence. CONCLUSIONS: A low-quality diet was associated with family income, sedentarism and geographical area. These data are extremely relevant to assist in coping with cardiovascular disease because they enable an assessment of the distribution of these factors in different regions of the country.
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Doenças Cardiovasculares , Dieta , Brasil , AteroscleroseRESUMO
INTRODUCTION: The management of patients with dyslipidemia (DLP) requires intensive medical follow-up as an essential part of treatment and to reduce the risk of cardiovascular (CV) outcomes. The aim of this study was to evaluate whether adherence to medical treatment changed the prevalence of CV disease events in a retrospective 7-year follow-up analysis. METHODS: This retrospective study involved 92 patients divided into two groups according to their adherence: the REG group with 64 patients who had medical appointments from 2012 to 2018, and the DROP group, with 28 patients who had medical appointments in 2012 but did not complete regular appointments until 2018. Cox proportional hazard models were fitted to estimate hazard ratios associated with CV outcomes as primary endpoints. RESULTS: We observed a total of 32 cases of acute myocardial infarction (AMI) in the study population, 17 (338.41 pY) in the REG group and 15 (62.97 pY) in the DROP group. An increased hazard of AMIs was observed in the DROP group compared with the REG group by follow-up time (p < 0.001). We found that previous events of AMI and congestive heart failure (CHF) were associated with progression to treatment dropout (p < 0.05) and that two drugs were considered a risk factor for treatment dropout, diuretics and fibrates (p < 0.05). CONCLUSIONS: A reduced hazard of AMI was observed in patients who complete a greater number of medical appointments and receive multidisciplinary treatment on a regular basis.
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Abstract Background Cardiovascular diseases (CVD) accounted for 27% of deaths in Brazil in 2017. Most of the recorded deaths caused by CVD would be preventable if patients controlled risk factors including inadequate diet. The Brazilian Cardioprotective Nutritional Program (Dica Br) adapted the Mediterranean diet pattern to Brazilian typical foods and evaluated the effectiveness of a nutritional program based on cardioprotective foods on cardiovascular events and death of patients with cardiovascular diseases. Objectives To evaluate the effect of Dica Br on the QoL of patients with atherosclerotic disease from two health centers in the city of Rio de Janeiro. Method Randomized clinical trial with 273 participants of both sexes, over 45 years old, followed for four years. The intervention group (IG) received individualized dietary prescription, educational program, individual and group consultations, and phone calls. The control group (CG) received general dietary guidance. The SF-36 was used to assess QoL. The Student's t-test and the Mann-Whitney test was used to compare means between the groups. The mixed model test was used to compare the course of variables over time between the groups. Statistical significance was set at 5%. Result Most patients were male, with an average age of 64.2 ± 8.2 years in the IG and 65±9.5 years in the CG. Most were physically inactive, overweight, and had incomplete elementary school. The most prevalent comorbidity was systemic arterial hypertension, followed by dyslipidemia. QoL improved in both groups at four years. Waist circumference decreased in both groups over time, and low-density lipoprotein cholesterol (LDL-C) levels decreased in the IG but not in the CG after four years of follow-up. Conclusion The cardioprotective diet was effective in reducing LDL-C in the IG, and an improvement in QoL was observed in both intervention and control groups.
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BACKGROUND: Nut consumption has been related to improvements on cardiometabolic parameters and reduction in the severity of atherosclerosis mainly in primary cardiovascular prevention. The objective of this trial is to evaluate the effects of the Brazilian Cardioprotective Diet (DIeta CArdioprotetora Brasileira, DICA Br) based on consumption of inexpensive locally accessible foods supplemented or not with mixed nuts on cardiometabolic features in patients with previous myocardial infarction (MI). METHODS: DICA-NUTS study is a national, multicenter, randomized 16-week follow-up clinical trial. Patients over 40 years old with diagnosis of previous MI in the last 2 to 6 months will be recruited (n = 388). A standardized questionnaire will be applied to data collection and blood samples will be obtained. Patients will be allocated in two groups: Group 1: DICA Br supplemented with 30 g/day of mixed nuts (10 g of peanuts, 10 g of cashew, 10 g of Brazil nuts); and Group 2: only DICA Br. The primary outcome will consist of LDL cholesterol means (in mg/dL) after 16 weeks of intervention. Secondary outcomes will consist of other markers of lipid profile, glycemic profile, and anthropometric data. DISCUSSION: It is expected that DICA Br supplemented with mixed nuts have superior beneficial effects on cardiometabolic parameters in patients after a MI, when compared to DICA Br. TRIAL REGISTRATION: ClinicalTrials.gov Identifier NCT03728127 . First register: November 1, 2018; Last update: June 16, 2021. World Health Organization Universal Trial Number (WHO-UTN): U1111-1259-8105.
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Dieta , Infarto do Miocárdio , Adulto , Biomarcadores , Glicemia , LDL-Colesterol , Humanos , Estudos Multicêntricos como Assunto , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/prevenção & controle , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
The COVID-19 pandemic has made it challenging for individuals and families to maintain a healthy lifestyle, quality of life, and well-being. Preliminary evidence have suggested that higher odds of both mortality and severity of the COVID-19 are closely associated to unhealthy lifestyle behaviors. Thus, in an effort to contribute to this challenging global situation, we joined a group of lifestyle medicine researchers and/or practitioners to provide scientifically sound information, recommendations, resources, and suggestions related to the main pillars of lifestyle medicine (healthy eating, physical activity, sleep, tobacco/alcohol, stress management, relationships, and planetary health) that may help health practitioners to support clients and patients maintain a healthy lifestyle during (and after) the COVID-19 crisis.
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Comparar a prevalência dos fatores de risco para doenças cardiovasculares em pacientes com fenótipo de HF com e sem mutação. Métodos: Estudo transversal com pacientes que apresentam níveis de LDL-c ≥ 190 mg/dl e história pessoal ou familiar de hipercolesterolemia com diagnóstico genético positivo ou negativo. Foi aplicado um questionário padronizado para obtenção de informações sobre os fatores de risco cardiovascular (idade, sexo, perfil bioquímico, histórico de DCV, tabagismo, HAS, DM tipo II e estado nutricional). Também foram realizadas avaliações antropométricas e laboratoriais. Os dados foram analisados no software IBM® SPSS® Statistics versão 21 e o nível de significância estatística foi estabelecido em p < 0,05. Resultados: Foram avaliados 103 pacientes de ambos os sexos (67% mulheres) com média de idade de 55,27 ± 15,07 anos. Trinta e três pacientes tinham diagnóstico de HF. A comorbidade mais prevalente foi a hipertensão arterial sistêmica (65,05%), seguida de sobrepeso/obesidade (57,28%) e diabetes mellitus tipo II (26,21%). Conclusão: Portadores de HF apresentaram menor prevalência de FR cardiovasculares, quando comparados com pacientes sem a mutação. No entanto, eles ainda merecem atenção diferenciada e focada no manejo de FR modificáveis, uma vez que a presença de pelo menos um FR já aumenta significantemente o risco CV nessa população
To compare the prevalence of risk factors for cardiovascular disease in patients with FH phenotype with and without mutation. Methods: A cross-sectional study with patients who present LDL-c levels ≥190mg/dL and a personal or family history of hypercholesterolemia with positive or negative genetic diagnosis. We applied a standardized questionnaire to obtain information on cardiovascular risk factors (age, sex, biochemical profile, history of CVD, smoking, hypertension, type 2 diabetes mellitus and nutritional status). Anthropometric measurements and laboratory tests were also performed. The data were analyzed using version 21 of the IBM® SPSS® Statistics software and statistical significance was established as p <0.05. Results: We studied 103 patients of both sexes (67% female) with a mean age of 55.27 ± 15.07 years. Thirty-three patients had a diagnosis of FH. The most prevalent comorbidity was systemic hypertension (65.05%), followed by overweight/obesity (57.28%) and type 2 diabetes mellitus (26.21%). Conclusion: The population with FH had lower cardiovascular RF prevalence when compared with patients without the mutation. However, they still merit differentiated care focused on the management of modifiable RFs, since the presence of at least one RF already significantly increases the CV risk in this population
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Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Fenótipo , Doenças Cardiovasculares , Prevalência , Fatores de Risco , Hiperlipoproteinemia Tipo II , Antropometria , Inquéritos e Questionários , Diabetes Mellitus , Aterosclerose , Sobrepeso , Estudo Observacional , Hipertensão , ObesidadeRESUMO
BACKGROUND: Familial hypercholesterolemia (FH) is a common autosomal dominant disorder, characterized by a high level of low-density lipoprotein cholesterol (LDL-C) and a high risk of premature cardiovascular disease. OBJECTIVE: To evaluate clinical and anthropometric characteristics of patients with the familiar hypercholesterolemia (FH) phenotype, with or without genetic confirmation of FH. METHODS: Forty-five patients with LDL-C > 190 mg/dl were genotyped for six FH-related genes: LDLR, APOB, PCSK9, LDLRAP1, LIPA and APOE. Patients who tested positive for any of these mutations were considered to have genetically confirmed FH. The FH phenotype was classified according to the Dutch Lipid Clinic Network criteria. RESULTS: Comparing patients with genetically confirmed FH to those without it, the former had a higher clinical score for FH, more often had xanthelasma and had higher LDL-C and apo B levels. There were significant correlations between LDL-C and the clinical point score for FH (R = 0.382, p = 0.037) and between LDL-C and body fat (R = 0.461, p = 0.01). However, patients with mutations did not have any correlation between LDL-C and other variables, while for those without a mutation, there was a correlation between LDL-C and the clinical point score. CONCLUSIONS: LDL-C correlated with the clinical point score and with body fat, both in the overall patient population and in patients without the genetic confirmation of FH. In those with genetically confirmed FH, there were no correlations between LDL-C and other clinical or biochemical variables in patients.
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LDL-Colesterol/genética , Hipercolesterolemia/genética , Hiperlipoproteinemia Tipo II/genética , Adulto , Idoso , Pesos e Medidas Corporais , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , FenótipoRESUMO
Abstract Background: Familial hypercholesterolemia (FH) is a common autosomal dominant disorder, characterized by a high level of low-density lipoprotein cholesterol (LDL-C) and a high risk of premature cardiovascular disease. Objective: To evaluate clinical and anthropometric characteristics of patients with the familiar hypercholesterolemia (FH) phenotype, with or without genetic confirmation of FH. Methods: Forty-five patients with LDL-C > 190 mg/dl were genotyped for six FH-related genes: LDLR, APOB, PCSK9, LDLRAP1, LIPA and APOE. Patients who tested positive for any of these mutations were considered to have genetically confirmed FH. The FH phenotype was classified according to the Dutch Lipid Clinic Network criteria. Results: Comparing patients with genetically confirmed FH to those without it, the former had a higher clinical score for FH, more often had xanthelasma and had higher LDL-C and apo B levels. There were significant correlations between LDL-C and the clinical point score for FH (R = 0.382, p = 0.037) and between LDL-C and body fat (R = 0.461, p = 0.01). However, patients with mutations did not have any correlation between LDL-C and other variables, while for those without a mutation, there was a correlation between LDL-C and the clinical point score. Conclusions: LDL-C correlated with the clinical point score and with body fat, both in the overall patient population and in patients without the genetic confirmation of FH. In those with genetically confirmed FH, there were no correlations between LDL-C and other clinical or biochemical variables in patients.
Resumo Fundamentos: A hipercolesterolemia familiar (HF) é uma doença autossômica dominante, caracterizada por altos níveis plasmáticos do colesterol da lipoproteína de baixa densidade (LDL-C) e pelo alto risco de desenvolvimento prematuro de doenças cardiovasculares. Objetivo: Avaliar características clínicas e antropométricas de pacientes com fenótipo para hipercolesterolemia familiar (HF), com ou sem diagnóstico genético de HF. Métodos: Quarenta e cinco pacientes com LDL-C > 190 mg/dL foram genotipados para seis genes relacionados com a HF: LDLR, APOB, PCSK9, LDLRAP1, LIPA e APOE. Pacientes que apresentaram resultado positivo para qualquer uma das mutações foram diagnosticados com HF por confirmação genética. O fenótipo para HF foi classificado pelo critério da Dutch Lipid Clinic Network. Resultados: Comparando os pacientes com a HF geneticamente confirmada com aqueles sem a confirmação, os primeiros apresentaram maior pontuação do escore para HF, uma maior frequência de xantelasma e maiores níveis de LDL-C e apo B. Houve correlações significativas entre o LDL-C e a pontuação do escore para HF (R = 0,382, p = 0,037) e entre LDL-C e gordura corporal (R = 0,461, p = 0,01). Os pacientes com mutações, no entanto, não apresentaram qualquer correlação entre o LDL-C e outras variáveis, enquanto aqueles sem mutação apresentaram correlação entre o LDL-C e a pontuação do escore. Conclusão: O LDL-C correlacionou-se com a pontuação do escore e com a gordura corporal, tanto na população total de pacientes quanto nos pacientes sem a confirmação genética de HF. Naqueles com HF geneticamente confirmada, não houve correlação entre o LDL-C e outras variáveis clínicas ou bioquímicas dos pacientes.
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Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Hipercolesterolemia/genética , Hiperlipoproteinemia Tipo II/genética , LDL-Colesterol/genética , Fenótipo , Pesos e Medidas Corporais , Estudos TransversaisRESUMO
INTRODUCTION: Obesity is a serious, worldwide and growing problem, with associated complications ranging from cardiovascular disease to cancer. It has been suggested that a subgroup of obese patients- the "metabolically healthy" (MH)- would constitute a phenotype whose cardiovascular risk would be closer to that of normal weight individuals and lower than that of obese patients with other risk factors. The definitions of MH obesity are heterogeneous, what makes the estimation of its prevalence quite difficult. Besides that, data are still controversial about the risk of incident cardiovascular disease in these patients and therefore this remains an unresolved matter. In parallel, the possibly lower risk of MH obesity may raise questions about the need for weight loss in MH obese patients. CONCLUSION: This issue should be carefully addressed, and evidence for a "benign" profile of MH obesity critically evaluated, as obesity is a risk factor for numerous health outcomes, and weight loss in obese people additionally offers protection against these nonmetabolic diseases.
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Doenças Cardiovasculares , Obesidade Metabolicamente Benigna , Animais , Biomarcadores/sangue , Doenças Cardiovasculares/sangue , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/fisiopatologia , Doenças Cardiovasculares/prevenção & controle , Metabolismo Energético , Nível de Saúde , Humanos , Incidência , Estado Nutricional , Obesidade Metabolicamente Benigna/sangue , Obesidade Metabolicamente Benigna/epidemiologia , Obesidade Metabolicamente Benigna/fisiopatologia , Obesidade Metabolicamente Benigna/terapia , Fenótipo , Prevalência , Prognóstico , Medição de Risco , Fatores de Risco , Redução de PesoRESUMO
In this systematic review, we discuss the scientific evidence about the effect of dietary intake of seeds and sesame derivatives on lipid profile and blood pressure (BP) of hypertensive and dyslipidemic individuals. Clinical trials published in English, Portuguese or Spanish were searched on the following databases: Lilacs, PubMed, Isi Web of Knowledge, Cochrane Library, Scopus, Trip Data Base and Scielo. The bibliographic search period was started in September 2013 and ended in January 2014. The biases of risk analysis were carried out considering 6 of the 8 criteria of the Cochrane Handbook for Systematic Reviews of Interventions Version 5.1. Of the 7 clinical trials included, five evaluating individuals with hypertension observed a significant reduction in systolic and/or diastolic blood pressure. The two articles that evaluated individuals with dyslipidemia showed improvement in lipid profile. The mechanisms of action are still being studied. Regarding the bias risk analysis, clinical trials included showed few descriptions of the methods applied. There are few studies about sesame ingestion, and it was observed high risk for bias in the selected studies. More standardized methods with attention to the design of studies are needed to improve the level of the evidence.
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Pressão Sanguínea , Dieta , Lipídeos/sangue , Sementes , Sesamum/química , Ensaios Clínicos como Assunto , Dislipidemias/tratamento farmacológico , Humanos , Hipertensão/tratamento farmacológico , Extratos Vegetais/uso terapêutico , Viés de Seleção , Óleo de Gergelim/uso terapêuticoRESUMO
This study is aimed at assessing the scientific evidence on the effect of the intake of sesame seeds and derivatives on oxidative stress of individuals with systemic hypertension, dyslipidemia, and type 2 diabetes mellitus. A systematic review was conducted in seven databases (Lilacs, PubMed, ISI Web of Knowledge, Cochrane Library, Scopus, Trip Database, and Scielo) from September 2013 to January 2014. Clinical trials on the intake of sesame seeds and derivatives assessing the outcomes related to oxidative stress were retrieved. The risk of bias in the results of the studies selected was assessed according to the criteria of the Cochrane Handbook for Systematic Reviews of Interventions. This review included seven clinical trials showing that the intake of sesame resulted in the increase in enzymatic and nonenzymatic antioxidants, as well as in a reduction in oxidative stress markers. This was mainly observed with the use of sesame oil for hypertensive individuals during 2 months and black sesame meal capsules for prehypertensive individuals during four weeks. Most studies involved a small number of participants, sample size being considered a limiting factor for this review. In addition, a significant heterogeneity was observed in the type of population studied and the type of sesame and derivatives used, as well as their amount. The follow-up time was considered a limiting factor, because it varied in the different studies. The high risk of randomization and blinding biases found in the studies assessed determines lower scientific evidence of the results. Despite the limitations and biases identified in this systematic review, sesame showed relevant effects on oxidative stress, suggesting it could increase the antioxidant capacity.
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Diabetes Mellitus Tipo 2/dietoterapia , Dislipidemias/dietoterapia , Hipertensão/dietoterapia , Estresse Oxidativo , Sementes/metabolismo , Sesamum/metabolismo , Ensaios Clínicos como Assunto , Diabetes Mellitus Tipo 2/metabolismo , Dislipidemias/metabolismo , Humanos , Hipertensão/metabolismo , Sementes/química , Sesamum/químicaRESUMO
Fundamentos: A apneia obstrutiva do sono (AOS) é uma doença crônica, subdiagnosticada, com alta taxa de morbimortalidade, associada à obesidade. Justifica-se este estudo pela elevada prevalência de obesidade e sua associação com a AOS. Objetivo: Avaliar fatores nutricionais, polissonográficos e de sonolência diurna excessiva (SDE) associados à gravidade da AOS. Métodos: Estudo transversal que compara alterações antropométricas e polissonográficas em indivíduos com e sem AOS. Avaliados índice de massa corpórea, escala de sonolência de Epworth e parâmetros polissonográficos. A síndrome de AOS foi classificada em: leve/moderada e grave, baseada no índice apneia/hipopneia. Resultados: Incluídos 288 pacientes, com média de idade 43,9±12,3 anos e índice de massa corpórea 29,4±6,38 kg/m2. Entre os pacientes com AOS grave, 92,0 % apresentaram excesso de peso. Mais da metade apresentava sonolência diurna (55,6 %). A presença de obesidade, sonolência diurna excessiva, roncos e de fragmentação do sono foi 3, 2, 11 e 23 vezes maior na AOS grave do que na leve/moderada. Conclusão: Indivíduos com apneia grave apresentaram maior IMC, mais sonolência diurna, mais fragmentação do sono e mais roncos do que aqueles com forma leve a moderada de AOS.
Background: Obstructive sleep apnea (OSA) is an underdiagnosed chronic disease associated with obesity and high morbidity and mortality rates. This study is justified by the high prevalence of obesity and its association with obstructive sleep apnea. Objective: To evaluate nutritional, polysomnographic and daytime sleepiness factors associated with OSA severity. Methods: Cross-sectional study comparing anthropometric and polysomnographic alterations in patients with and without OSA, assessing body mass index, subjective Epworth sleepiness scale (ESS) and polysomnography parameters. The OSA syndrome was classified as mild/moderate or severe, based on the apnea/hypopnea rates. Results: A total of 288 patients were included, with a mean age of 43.9±12.3 years and a body mass index of 29.4±6.38kg/m2. Among patients with severe OSA, almost 92.0% were overweight and more than half (55.6%) presented excessive daytime sleepiness. Obesity, excessive daytime sleepiness, snoring and sleep fragmentation were respectively 3, 2, 11 and 23 times greater with severe OSA than for mild/ moderate OSA. Conclusion: People with severe OSA presented higher BMIs, more frequent daytime sleepiness, greater sleep fragmentation and more frequent snoring than those with mild/moderate OSA.
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Humanos , Masculino , Feminino , Adulto , Apneia Obstrutiva do Sono/epidemiologia , Doenças Cardiovasculares/prevenção & controle , Obesidade/complicações , Doença Crônica/reabilitação , Fases do Sono , Fatores de Risco , Prevalência , Sons Respiratórios , Índice de Massa CorporalRESUMO
OBJECTIVES: This study examined the effect of Vitis vinifera grape skin extract (ACH09) on hyperglycaemia and the insulin-signalling cascade in alloxan-treated mice. METHODS: Glycaemia, serum insulin and Western blot analysis of insulin cascade proteins were evaluated in the gastrocnemius muscles of four groups of adult mice: control, ACH09 (200 mg/kg per day, p.o.), alloxan (300 mg/kg, i.p.) and alloxan + ACH09. Insulin secretion in isolated pancreatic islets was also studied. KEY FINDINGS: Glycaemia values in the alloxan + ACH09 and ACH09 groups were significantly lower than in the alloxan-treated and control groups, respectively. Increased insulin resistance (HOMA index) was observed in the alloxan-treated group but not in the alloxan + ACH09 group. Insulin receptor content and Akt phosphorylation were significantly greater in the alloxan + ACH09 group compared with the alloxan-treated group. The glucose transporter (GLUT-4) content was reduced in alloxan-treated mice compared with the control group, while alloxan + ACH09 and ACH09-treated mice showed a significant increase in GLUT-4 content. ACH09 treatment did not change glucose-induced insulin secretion in isolated pancreatic islets. CONCLUSIONS: The results suggest that ACH09 has hypoglycaemic and antihyperglycaemic effects that are independent of an increase in insulin release but are probably dependent on an increase in insulin sensitivity resulting from an activation of the insulin-signalling cascade in skeletal muscle.
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Diabetes Mellitus Experimental/tratamento farmacológico , Hiperglicemia/tratamento farmacológico , Hipoglicemiantes/farmacologia , Insulina/sangue , Extratos Vegetais/farmacologia , Vitis/química , Aloxano , Animais , Glicemia/metabolismo , Western Blotting , Peso Corporal , Diabetes Mellitus Experimental/sangue , Modelos Animais de Doenças , Hiperglicemia/sangue , Masculino , Camundongos , Músculo Esquelético/metabolismo , Receptor de Insulina/metabolismoRESUMO
A insuficiência cardíaca (IC) é a evolução final das várias formas de doenças cardiovascular, sendo resultado de modificações estruturais, metabólicas e de contratilidade miocárdica. A fim de compreender o papel na dinâmica do metabolismo cardíaco no estado basal e na sobrecarga de pressão, utilizamos os modelos de cre-lox com deleção específica no coração para substrato do receptor de insulina (IRS) e co-ativador do PPAR (PGC-1b) e analisamos a estrutura cardíaca (histologia e estereologia), função cardíaca (ecocardiograma e técnica de Working heart), o metabolismo (isolamento de cardiomiócito e captação de glicose), ação hormonal (Western Blotting), expressão gênica (PCR-RT) de enzimas do metabolismo (lipídico, glicídico, da cadeia respiratória fatores transcricionais e hipertróficos) e a função mitocondrial. Verificamos, nos CIRS12KO, disfunção cardíaca grave, disfunção mitocondrial e prejuízo na expressão gênica das enzimas do metabolismo energético. Nos PGC-1BKO observamos disfunção mitocondrial e alteração de expressão gênica das enzimas do metabolismo energético quando submetidos à sobrecarga de pressão. Através do estudo do metabolismo cardíaco e da expressão gênica nestes diferentes modelos conseguimos explorar as vias metabólicas que levam a hipertrofia compensada à IC. Sugerimos que o mecanismo responsável pela descompensação seja a disfunção mitocondrial em conseqüência à alteração da expressão gênica. E que IRS e o PGC-1B são fatores chaves da dinâmica cardíaca, e que são indispensáveis para a estrutura e funcionamento cardíaco. Além de representar alvo promissor para limitar a transição de hipertrofia cardíaca compensada a insuficiência cardíaca...
Heart failure (HF) is the end stage of different types of cardiovascular diseases and it is characterized by changes in the metabolic and myocardial contractility. We use the models cre-lox with specific knockout for insulin receptor substrate (IRS) and co-activator of PPAR (PGC-1b) (basal and pressure overload). The objective was understood the role in the dynamics of cardiac metabolism. We analyzed cardiac structure (histology and stereology), cardiac function (echocardiography and the working heart technique), metabolism (glucose uptake), hormonal action (Western Blotting), gene expression (RT-PCR) from enzyme metabolism (lipid, carbohydrates, respiratory chain, transcriptional and hypertrophic factors) and mitochondrial function. We found in CIRS12KO, severe cardiac dysfunction, mitochondrial dysfunction and reduction of gene expression. And in the PGC-1bKO when subjected to pressure overload, the progression to heart failure, with mitochondrial dysfunction, and alteration of gene expression from enzyme metabolism. The data show that changes on cardiac metabolism and gene expression in both models explain the metabolic pathways that lead to compensated hypertrophy to HF. We suggest that the mitochondrial dysfunction and the gene expression was possible mechanisms for HF. We conclude that IRS and PGC-1b are key factors of cardiac dynamics, which are essential to the structure and heart function. IRS and PGC-1b represent a promising target for limiting the transition from compensated cardiac hypertrophy to heart failure...