Síndrome metabólica: complacência arterial e a velocidade de onda de pulso

A Sindrome Metabolica (SM) caracteriza-se como um disturbio complexo representado por um conjunto de fatores de risco cardiovascular, tendo sua frequencia estimada entre 20% a 25% da populacao adulta mundial. Os diversos componentes da SM sao responsaveis por alteracoes estruturais e funcionais de grandes arterias, dentre as quais destaca-se a diminuicao da complacencia arterial como um importante marcador de risco cardiovascular. A medida da Velocidade de Onda de Pulso (VOP) configura-se como um metodo relevante na avaliacao da rigidez arterial. Discute-se, nesta revisao, os principais mecanismos pelos quais os componentes da SM atuam provocando estas alteracoes vasculares, a relevância destas modificacoes e o reflexo da influencia terapeutica nestes casos. A revisao bibliografica foi realizada atraves de consulta as bases de dados eletronicos Medline, Lilacs e Pubmed, entre os anos de 2008 e 2009. Foram utilizados os descritores “metabolic syndrome”, “pulse wave velocity” e “arterial stiffness”, nos idiomas portugues e ingles, sendo selecionados estudos datados entre 1962 e 2009. Observou-se atraves dos estudos revisados que os componentes da SM atuam atraves de diferentes mecanismos para promover o aumento da VOP. A principal alteracao vascular relacionada a estes componentes foi a diminuicao da complacencia das grandes arterias. A avaliacao da complacencia arterial atraves da medida da VOP permite o acompanhamento dos resultados obtidos atraves das intervencoes terapeuticas e a identificacao precoce destas alteracoes vasculares. Desta forma, torna-se possivel a adocao de uma medida terapeutica precoce, possibilitando diminuir significativamente a progressao destas alteracoes vasculares e, portanto, reduzir a mortalidade cardiovascular destes pacientes. The metabolic syndrome (MS) is characterized as a complex disorder represented by a set of cardiovascular risk factors, its frequency estimated between 20% to 25% of the adult population worldwide. The various components of MS are responsible for structural and functional alterations of large arteries, among which a decrease in arterial compliance stands out as an important cardiovascular risk marker. Measurement of Pulse Wave Velocity (PWV) figures as a relevant method in the evaluation of arterial stiffness. This review discusses the main mechanisms by which components of MS act causing these vascular changes, the relevance of these changes and the reflex of treatment influence in these cases. A literature review was conducted by consulting electronic databases Medline, Pubmed and Lilacs between years 2008 and 2009. Metabolic syndrome, pulse wave velocity and arterial stiffness, and their Portuguese equivalents, were the search words used, selecting studies dating from 1962 to 2009. The reviewed studies showed that the components of MS act through different mechanisms to promote the increase of PWV. The main change related to these vascular components was decreased compliance of large arteries. Assessment of arterial compliance by measuring PWV allows tracking the results obtained through therapeutic interventions and early identification of these vascular changes. It thus becomes possible to adopt an early treatment measure, which allows to slow down the progression of these vascular changes significantly and therefore reduce cardiovascular mortality in these patients.