Alterações cardíacas associadas à obesidade e à síndrome metabólica

Abstract

The change in lifestyle in recent decades has led to the increased number of obese worldwide. Currently, obesity is seen as a public health problem worldwide, because such studies have shown that excess body fat is associated with the development of several diseases, including metabolic disorders and cardiovascular disease. In this sense, the interest for treatments to reduce body weight increased and nowadays bariatric surgery is among the most effective methods to treat obesity. Candidates for such surgery are characterized by having severe obesity, and its associated comorbidities. However, despite the association between obesity and cardiovascular diseases is quite disclosed, a description of the metabolically benign obesity, where there is less risk of developing atherosclerosis led to questions about the cardiac health of obese individuals not suffering from metabolic syndrome. To contribute to the resolution of this issue, this thesis presents two papers. The first paper it’s a narrative review which presented state of the art on the pathophysiological mechanisms that link the metabolic syndrome (MS) components to the development of cardiovascular disease. The second paper is the result of a descriptive study of cases and controls, which evaluated the occurrence of electrocardiographic and echocardiographic changes in obese subjects with (cases) and without (controls) MS, referred for cardiac evaluation preoperative bariatric surgery. A total of 153 subjects were evaluated. 20.9% of those not present MS. The results showed that in this sample the frequency of echocardiography (ECHO) and electrocardiography (ECG) changes was similar in both groups (with and without MS), with values statistically equal. Evaluating the metabolic syndrome components individually, hypertension was associated with changes in both examinations, observing in individuals with hypertension 4.27 times risk of presenting ECG changes and 3.32 times risk to present ECHO changes. Moreover, for the present sample, low HDL shown to be a protective factor for the presence of echocardiographic change, so that subjects with low HDL showed 0.34 risk to develop changes of ECHO. This findings showed that the absence of MS in obese people did not reduce the risk of changes in ECG and ECHO tests in obese bariatric surgery candidates and that it's necessary to have adequate attention to cardiovascular health of such individuals.