Distribuição de gorduras subcutânea, visceral e perirrenal, perfil metabólico, massa corporal e pressão arterial em pacientes com e sem síndrome coronariana aguda

Abstract

Background: Changes in the distribution of body fat deposits, metabolic profile, body mass and systemic blood pressure can characterize a set of pro-atherogenic and pro-thrombotic risk factors and lead to physical disability or death caused by cardiovascular disease atherosclerosis and its ischemic events. Acute coronary syndrome (ACS) is characterized by clinical and laboratory manifestations resulting from myocardial ischemia, which may present as unstable angina (UA) or myocardial infarction (AMI) with or without ST segment elevation22. Some of these risk factors may have greater or lesser expression as predictors of ischemic events with atherosclerotic causes, and may be identified in the initial moments that follow the cascade of classic thrombotic events in ACS. Objectives: This study had, as a general objective, to identify patterns that have a potential effect in triggering the ischemic event and that may be present in individuals before and after the initial moments of ACS and, as a secondary objective, to analyze anthropometric aspects, plasma metabolic variables and blood pressure and subcutaneous (GSC), visceral (GV) and perirrenal (GPR) fat distribution in these individuals. Materials and Methods: 111 volunteers were studied and divided into two groups, one consisting of 33 patients with ACS diagnosed for a maximum of five days, and treated at the Cardiology service of the Hospital de Clínicas of the Federal University of Uberlândia, during the year of 2019; the second group consisted of 78 healthy volunteers without acute coronary syndrome, data that are part of the Uberlândia Heart Study, were randomly selected from a population of individuals who demanded services from the hospital's general outpatient clinic. The groups were matched for sex and age. Blood samples were obtained from participants in both groups for measurements of plasma lipids (HDL and LDL-cholesterol and triglycerides) and fasting glucose. Anthropometric measurements were conventionally performed using a stadiometer, measuring tape and scale. Systemic blood pressure was measured using a sphygmomanometer. Measurements of GSC, GV, and GPR deposits were performed by a single observer using ultrasonography. Comparisons were made taking into account sex and the presence or absence of acute coronary syndrome. In the statistical comparison between the groups, the Mann Whitney U test was used and p values <0.05 were considered significant. Effect size was estimated by the Cohen test. As a cut off point for comparisons, the references contained in the V Brazilian Guideline on Dyslipidemia and Prevention of Atherosclerosis were followed. Results are presented as mean and standard deviation; t and binomial tests for proportions were used for comparisons, and p values <0.05 were considered significant. Results: In female participants with ACS, waist circumference, total cholesterol, non-HDL cholesterol, LDL-cholesterol and subcutaneous fat were lower, with effect sizes ranging from moderate to large. GV and GPR were higher in the presence of SCA. There was no difference regarding age, body mass index and HDL-cholesterol. In men, only GV was increased, with an effect size considered large. There was a trend towards the occurrence of smaller subcutaneous fat deposits in patients with ACS (p = 0.07). No differences were found regarding age, body mass index, waist circumference, total cholesterol, non-HDL cholesterol, HDL-cholesterol, LDL-cholesterol, triglycerides, fasting glucose and GPR. Most patients of both sexes with ACS had diabetes mellitus. The prevalence of systolic arterial hypertension (SBP) was higher in women. As for metabolic profiles, most parameters in both groups and in both sexes were similar and considered adequate, except for women's waist circumference, which was higher in both groups. The BMI in women in the control group and in men in both groups was also higher, as was the SBP in men in the control group. Conclusions: The differentiating factors of the groups are different when considering sex. In women with ACS, smaller measures of waist circumference, total cholesterol, LDL-cholesterol and GSC and larger GV and GPR deposits were observed; in men, only GV was increased, which is the only differentiator of the ACS group to present a great magnitude of effect in both sexes. Most of the metabolic parameters of both groups are in accordance with desirable standards. Only the BMI of women in the control group and men with and without ACS were significantly higher when comparing the groups to each other.