O papel das estratégias de mudanças do estilo de vida para a redução de eventos ateroscleróticos / The role of lifestyle changes strategies for atherosclerotic events reduction

Neste artigo, a autora avalia as estratégias de mudança do estilo de vida para redução do risco de eventos cardiovasculares. Inicialmente, situa a doença ateroscierótíca (DAC) e seus principais eventos infarto do miocárdio e acidente vascular cerebral como as principais causas de morte no mundo ocidental, que aumentam anualmente, sendo considerada a doença ateroscierótica uma doença da vida moderna. Neste sentido, realiza ampla revisão bibliográfica mencionando as diretrizes e metas da Sociedade Brasileira de Cardiologia-Departamento de Aterosolerose. Em seguida, nas estratégias de mudança do estilo de vida, menciona o abandono do tabagismo, os benefícios terapêuticas da atividade física e a importância da dieta, apresentando amplos dados bibliográficos com referência à modificação do perfil lipídico e da função endotelial e suas aplicações clínicas. Na discussão, apresenta resultados favoráveis e outras publicações sobre a associação entre o exercício físico e o risco do desenvolvimento da DAC, comprovando a necessidade da promoção da atividade física como prioridade da saúde pública. Com relação à terapêutica dietética, salienta a importância das fibras (soluvéis e insolúveis) e suas fontes, bem como as recomendações das quantidades nos Estados Unidos da América do Norte. Menciona o mecanismo de ação das fibras e os dados epidemiológicos que relacionam sua ingestão com a diminuição da incidência de coronariopatias, bem como ações da fibra dietática sobre a redução dos níveis de lipídeos (colesterol) e também a importância das fibras na terapêutica das dislipidemias, sendo atualmente reconhecidas como alimentos funcionais.

Diabetes and atherosclerosis as immune-inflammatory disorders: options for reversal of disease processes.

Hypothesis is presented to suggest that the present epidemic of DM and ACVD in Asian indians and possibly in other communities is iatrogenic resulting from what may be called modern malnutrition due to increased intake of total and n-6 fats and decreased intake of n-3 fat and antioxidants. Such a diet induces oxidative stress and activates the immune system. Imbalance between n-6 and n-3 fats result in inappropriate immune response. It also leads to increased and unbalanced biosynthesis of metabolites of n-6 fats. These are immune suppressive, proinflammatory and thrombogenic. They also contribute to insulin resistance and dyslipidemias. This makes DM and atherosclerosis as malnutrition related oxidative immune inflammatory disorders. Various risk factors are also the result of the same inappropriate response. Our intervention studies give considerable support to this hypothesis. It is suggested that simple correction of diet defects can reverse the disease process and thereby offer a simple, practical therapeutic option not only for the primary prevention of each of these disorders or their complications but also for the so called risk factors for these diseases. It is suggested that the real remedy for DM, ACVD and all the risk factors lies not in drugs or surgery but in the kitchen. However more studies are needed to precisely define various molecular mechanisms involved or the exact requirements of various nutrients.

Effect of skim milk on progression of atherosclerosis in cholesterol-fed rabbits.

Effect of skim milk on progression of atherosclerosis was studied in cholesterol-fed rabbits. Rabbits were given a high cholesterol food (0.5%) with skim milk powder (16%) or no milk (control group). At 12 wk, the plasma cholesterol level was significantly higher in the control group (1605 mg/d1) than in the milk-fed group (1146 mg/d1). The contents of esterified cholesterol and elastin in the aorta were higher in the control group than in the milk-fed group by 28 an 94 per cent, respectively. The differences between the two groups in the contents of aortic triacylglycerols, mucopolysaccharides, collagen and unesterified cholesterol were not significant. The difference in sudanophilic area in the aorta between the control (35%) and the milk-fed groups (31%) was not significant. However, intimal proliferation and medial involvement in the aortic lesions were more severe in the control group. These findings suggest that skim milk can slow down the process of cholesterol induced atherogenesis.

Role of Bengal gram (Cicer arietinum) seed coat as an antiatherogenic agent in rabbits.

Bengal gram seed coat appeared to be a potent hypocholesterolemic/hypolipidemic agent in rabbits. When fed to hypercholesterolemic rabbits, it lowered hepatic cholesterol/lipid much more than in the control group. Aortic lipid levels were rather marginally increased but the increase was less in Bengal gram seed coat fed rabbits. Though seed coat of Bengal gram failed to prevent the development of atherosclerosis in hypercholesterolemic rabbits, but certainly it slowed down the process of its development. The hypocholesterolemic action of Bengal gram seed coat appeared to be due to the increased catabolism and excretion of cholesterol.

Studies on serum and tissue lipid fractions in Bengal gram induced retardation of experimental atherosclerosis.

Serum and tissue lipid levels were studied in rabbits in whom egg yolk was used to induce atherosclerosis and Bengal gram was supplemented in the diet as a lipodiatic agent. Monthly serological and tissue studies were done to assess the levels of total cholesterol, triglycerides and phospholipids and it was found that egg yolk feeding leads to statistically significant increases in all these fractions in the serum, liver, adrenals, heart and aorta. Bengal gram supplementation of the diet led to flattening of the atherosclerotic plaques and showed statistically significant decline in the organs with the exception of the kidney. This study confirms the lipodiatic effect of the bengal gram and its beneficial effect on the atherosclerotic plaque.