Homocisteína e risco cardiovascular
Palavras-chave:
Aterosclerose, Doenças cardiovasculares, Hiper-homocisteinemia, Homocisteín, Óxido nítricoResumo
Numerosos estudos epidemiológicos têm demonstrado que a hiper-homocisteinemia é um forte e independente fator de risco para o desenvolvimento da doença vascular. A hiper-homocisteinemia pode ser decorrente da deficiência de enzimas envolvidas no metabolismo desse aminoácido ou de seus cofatores (vitaminas). Várias hipóteses têm sido propostas para explicar o mecanismo celular que envolve a hiper-homocisteinemia e a doença vascular, como o estresse oxidativo. Os fatores de risco convencionais para doenças vasculares, como a aterosclerose, incluem hipercolesterolemia, hipertensão arterial, diabetes mellitus e tabagismo, que respondem por aproximadamente 50% dos casos. Evidências indicam atualmente que a hiper-homocisteinemia ocorre em aproximadamente 5% a 7% da população em geral e que é um importante fator de risco independente para o desenvolvimento da aterosclerose. No Brasil, a doença vascular é responsável por mais de 300 mil mortes por ano e corresponde a 16% dos gastos do Sistema Único de Saúde. Contudo mais de 40% dos pacientes diagnosticados com doença coronária prematura, vascular periférica ou trombose venosa recorrente apresentam hiper-homocisteinemia. Nessa revisão, serão abordadas as condições que conduzem à hiper-homocisteinemia, tais como fatores genéticos e nutricionais, e os mecanismos pelos quais a hiper-homocisteinemia potencializa o desenvolvimento da aterosclerose. O presente trabalho foi desenvolvido por meio de revisão sistemática da literatura nacional e internacional pelo indexador MedLine/PubMed, utilizando os unitermos: homocisteína, cardiovascular, risco, aterosclerose, radicais livres.
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