Metabolic x Syndrome – ABC CARDIOL

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Letter to the Editor

Extracellular Matrix Turnover: a Balance between MMPs and their Inhibitors

Emre Yalcinkaya et al. Murat Celik Baris Bugan

To the Editor,

We read with great interest the article by Santos et al, entitled “Early Change of Extracellular Matrix and Diastolic Parameters in Metabolic Syndrome”, which was published in october of Arquivos Brasileiros de Cardiologia. The authors aimed to compare diastolic function, biomarkers representing extracellular matrix activity (MMP9 and TIMP1), inflammation and cardiac hemodynamic stress in patients with the metabolic syndrome and healthy controls. We thank authors for their excellent data and valuable study but some comments may be of beneficial.

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Artigo Original

Metabolic Syndrome, Strain, and Reduced Myocardial Function: Multi-Ethnic Study of Atherosclerosis

André Luiz Cerqueira de Almeida et al. Gisela Teixido-Tura Eui-Young Choi Anders Opdahl … Verônica R. S. Fernandes Colin O. Wu David A. Bluemke João A. C. Lima

Background:

Subclinical cardiovascular disease is prevalent in patients with Metabolic Syndrome (MetSyn). Left ventricular (LV) circumferential strain (ε_CC) and longitudinal strain (ε_LL), assessed by Speckle Tracking Echocardiography (STE), are indices of systolic function: shortening is indicated by negative strain, and thus, the more negative the strain, the better the LV systolic function. They have been used to demonstrate subclinical ventricular dysfunction in several clinical disorders.

Objective:

We hypothesized that MetSyn is associated with impaired myocardial function, as assessed by STE.

Methods:

We analyzed Multi-Ethnic Study of Atherosclerosis (MESA) participants who underwent STE and were evaluated for all MetSyn components.

Results:

Among the 133 participants included [women: 63%; age: 65 ± 9 years (mean ± SD)], the prevalence of MetSyn was 31% (41/133). Individuals with MetSyn had lower ε_CC and lower ε_LL than those without MetSyn (-16.3% ± 3.5% vs. -18.4% ± 3.7%, p < 0.01; and -12.1% ± 2.5% vs. -13.9% ± 2.3%, p < 0.01, respectively). The LV ejection fraction (LVEF) was similar in both groups (p = 0.09). In multivariate analysis, MetSyn was associated with less circumferential myocardial shortening as indicated by less negative ε_CC (B = 2.1%, 95%CI:0.6 3.5, p < 0.01) even after adjusting for age, ethnicity, LV mass, and LVEF). Likewise, presence of MetSyn (B = 1.3%, 95%CI:0.3 2.2, p < 0.01) and LV mass (B = 0.02%, 95% CI: 0.01-0.03, p = 0.02) were significantly associated with less longitudinal myocardial shortening as indicated by less negative ε_LL after adjustment for ethnicity, LVEF, and creatinine.

Conclusion:

Left ventricular ε_CC and ε_LL, markers of subclinical cardiovascular disease, are impaired in asymptomatic individuals with MetSyn and no history of myocardial infarction, heart failure, and/or LVEF < 50%.

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Alimentary Habits, Physical Activity, and Framingham Global Risk Score in Metabolic Syndrome

Thays Soliman Soares et al. Carla Haas Piovesan Andréia da Silva Gustavo Fabrício Edler Macagnan … Luiz Carlos Bodanese Ana Maria Pandolfo Feoli

Background:

Metabolic syndrome is a complex disorder represented by a set of cardiovascular risk factors. A healthy lifestyle is strongly related to improve Quality of Life and interfere positively in the control of risk factors presented in this condition.

Objective:

To evaluate the effect of a program of lifestyle modification on the Framingham General Cardiovascular Risk Profile in subjects diagnosed with metabolic syndrome.

Methods:

A sub-analysis study of a randomized clinical trial controlled blind that lasted three months. Participants were randomized into four groups: dietary intervention + placebo (DIP), dietary intervention + supplementation of omega 3 (fish oil 3 g/day) (DIS3), dietary intervention + placebo + physical activity (DIPE) and dietary intervention + physical activity + supplementation of omega 3 (DIS3PE). The general cardiovascular risk profile of each individual was calculated before and after the intervention.

Results:

The study included 70 subjects. Evaluating the score between the pre and post intervention yielded a significant value (p < 0.001). We obtained a reduction for intermediate risk in 25.7% of subjects. After intervention, there was a significant reduction (p < 0.01) on cardiovascular age, this being more significant in groups DIP (5.2%) and DIPE (5.3%).

Conclusion:

Proposed interventions produced beneficial effects for reducing cardiovascular risk score. This study emphasizes the importance of lifestyle modification in the prevention and treatment of cardiovascular diseases.

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Artigo Original

Aerobic training does not alter blood pressure in menopausal women with metabolic syndrome

Aluísio Henrique Rodrigues de Andrade Lima et al. Henrique Eduardo Couto Glêbia Alexa Cardoso Lidiane Tavares Toscano … Alexandre Sérgio Silva Maria Paula Gonçalves Mota

BACKGROUND: Arterial Hypertension (AH) is an aggravating condition for Metabolic Syndrome (MS), as well as being aggravated by it. Menopause can make hypertension treatment more difficult, as it favors the worsening of MS components. Although there is evidence that exercise training reduces blood pressure, whether menopause and SM affect the exercise-induced benefits is yet to be elucidated. OBJECTIVE: To compare the effects of aerobic training on blood pressure in non-menopausal and menopausal women with MS METHODS: A total of 44 women were recruited and divided into four groups: non-menopausal control (NMC: 39.5 ± 3.6 years, n = 11); menopausal control (MC: 54.9 ± 5.9 years, n = 12), non-menopausal aerobics (NMA: 43.1 ± 6.8 years, n = 11) and menopausal aerobics (MA: 52.1 ± 5 years, n = 10). The exercise groups performed aerobic training for three months, five times a week, at an intensity between 60% and 70% of heart rate reserve. The resting blood pressure and blood pressure response after 60 minutes of exercise were measured before and after the training period. The two-way ANOVA test was used, considering a p value 0.05). CONCLUSION: Three months of aerobic training improved MS components, but did not alter resting blood pressure or the BP response after an acute exercise session in women with MS.

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Extracellular Matrix Turnover: a Balance between MMPs and their Inhibitors

Metabolic Syndrome, Strain, and Reduced Myocardial Function: Multi-Ethnic Study of Atherosclerosis

Background:

Objective:

Methods:

Results:

Conclusion:

Alimentary Habits, Physical Activity, and Framingham Global Risk Score in Metabolic Syndrome

Background:

Objective:

Methods:

Results:

Conclusion:

Aerobic training does not alter blood pressure in menopausal women with metabolic syndrome

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