Jornal Vascular Brasileiro
https://www.jvascbras.org/article/doi/10.1590/S1677-54492010000100006
Jornal Vascular Brasileiro
Review Article

Tratamento dietético da hiper-homocisteinemia na doença arterial periférica

Dietary treatment of hyperhomocysteinemia in peripheral arterial disease

Luciene de Souza Venâncio; Roberto Carlos Burini; Winston Bonetti Yoshida

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Resumo

A homocisteína está envolvida na gênese da aterosclerose e, assim, é considerada um importante e prevalente fator de risco na doença arterial periférica. O estado nutricional vitamínico deficiente, em especial do folato, é a principal causa de hiper-homocisteinemia nesses casos. Embora ainda não haja consenso sobre a dose exata e a forma de utilização do folato em suplementos e sobre adequação alimentar ou fortificação de cereais para o tratamento da hiper-homocisteinemia, diversos estudos realizados em pacientes com doença vascular periférica mostraram que o folato, isoladamente, pode reduzir as concentrações de homocisteína, bem como a concentração de alguns marcadores biológicos do processo de aterosclerose. No entanto, estudos recentes não comprovaram esse benefício sobre o processo inflamatório associado à hiper-homocisteinemia. Desta forma, embora a utilização isolada do folato seja uma terapêutica custo-efetiva no controle da hiper-homocisteinemia, seu impacto na evolução das doenças arteriais ainda persiste inconclusivo. Esta revisão abordará os efeitos obtidos com as diversas formas de utilização do folato no tratamento da hiper-homocisteinemia.

Palavras-chave

Homocisteína, aterosclerose, vitamina, ácido fólico

Abstract

Homocysteine plays a role in the genesis of atherosclerosis and, thus, it is considered an important and prevalent risk factor for peripheral arterial disease. Impaired vitamin nutritional status, especially regarding folate, may be mainly attributed to hyperhomocysteinemia. Although there is still no consensus as to the exact dose and method of use of folate in supplements, dietary adjustment or cereal fortification for the treatment of hyperhomocysteinemia, several studies conducted in patients with peripheral vascular disease have shown that isolated folate may reduce homocysteine levels, as well as the levels of some biological markers in the atherosclerotic process. However, recent studies have not corroborated this benefit for the inflammatory process associated with hyperhomocysteinemia. Consequently, although the use of folate is a cost-effective therapy for the control of hyperhomocysteinemia, its impact on the evolution of vascular diseases remains inconclusive. This literature review addresses the effects of several forms of folate therapies in the treatment of hyperhomocysteinemia.

Keywords

Homocysteine, atherosclerosis, vitamin, folic acid

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