UTILIZAÇÃO DE FITOESTERÓIS NO TRATAMENTO DA HIPERCOLESTEROLEMIA E PREVENÇÃO DE DOENÇAS CARDIOVASCULARES

Introducao: As doencas cardiovasculares acometem principalmente o coracao, sendo responsaveis por um percentual significativo de obitos em adultos em todo o mundo, e tem como principais fatores de risco associados os habitos de vida, idade acima de 40 anos, alem da hipertensao arterial, Diabetes mellitus e as dislipidemias, marcadas principalmente pela elevacao de LDL-c e colesterol total. Diante da magnitude do problema, e importante a implantacao de estrategias e condutas que visem a prevencao e o controle dos agravos associados. Nesse sentido, o consumo de fitoesterois, que sao compostos bioativos encontrados em alimentos de origem vegetal, sobretudo nos oleos de soja, canola e girassol, tem sido associado a melhora do perfil lipidico. Objetivo: Analisar a eficacia dos fitoesterois no tratamento da hipercolesterolemia e prevencao de doencas cardiovasculares. Metodologia: Trata-se de uma revisao literaria realizada por meio de levantamento nas bases de dados BVS e Pubmed; Em ingles, espanhol e portugues, publicados entre 2010 e 2018. Foram selecionados e analisados quatro artigos ligados diretamente ao tema em estudo. Resultados: Os artigos encontrados indicaram que o consumo de fitoesterois acima de 2g/dia reduz a absorcao intestinal de colesterol e consequentemente diminui a concentracao plasmatica de LDL–c por competir com o colesterol pela solubilizacao e pelo sitio de absorcao das micelas mistas da luz intestinal, devido suas semelhancas estruturais, o que diminui a quantidade de colesterol disponivel para absorcao. Outro mecanismo envolvido nessa diminuicao e a modificacao na expressao de genes que codificam as proteinas transportadoras de esterois (NPC1-L1), reduzindo o transporte de colesterol para os enterocitos, resultando em uma menor taxa de esterificacao do colesterol no enterocito e aumento da remocao deste do organismo por meio da excrecao trans intestinal do colesterol. Estudos clinicos comprovaram que a associacao da ingestao/suplementacao de fitoesterois junto a terapia medicamentosa com uso das estatinas apresentou uma reducao 1 adicional significativa dos niveis de LDL-c, e pode portanto ser considerada uma boa estrategia terapeutica. Conclusao: A utilizacao de fitoesterois por meio da ingestao de alimentos enriquecidos com esse composto e/ou por meio de suplementacao apresentou efeitos positivos sobre a reducao de niveis de LDL-c e colesterol total em individuos com hipercolesterolemia e baixo risco cardiovascular que nao possuem indicacao de farmacoterapia, ou ainda como adjuvante da terapia farmacologica em pacientes nao responsivos as estatinas. Ainda que poucos estudos comprovam a relacao direta com a reducao do risco para doencas cardiovasculares, a diminuicao das concentracoes plasmaticas de LDL-c ja se determina um fator importante na reducao desse risco. Palavras - chave: Alimentos, dislipidemias, fitoesterois. ABSTRACT: Cardiovascular diseases mainly affect the heart, being responsible for a significant percentage of deaths in adults around the world, and its main risk factors are life habits, age above 40 years, besides arterial hypertension, Diabetes mellitus and the dyslipidemias, marked mainly by the elevation of LDL-c and total cholesterol. Given the magnitude of the problem, it is important to implement strategies and behaviors that aim at the prevention and control of associated diseases. In this sense, the consumption of phytosterols, which are bioactive compounds found in foods of plant origin, especially soybean, canola and sunflower oils, has been associated with an improvement in the lipid profile. Objective: To analyze the efficacy of phytosterols in the treatment of hypercholesterolemia and the prevention of cardiovascular diseases. Methodology: This is a literary review carried out by means of a survey in the VHL and PubMed databases; In English, Spanish and Portuguese, published between 2010 and 2018. Four articles directly linked to the topic were selected and analyzed. Results: The articles found indicated that the consumption of phytosterols above 2 g / day reduces the intestinal absorption of cholesterol and consequently decreases the plasma concentration of LDL-c by competing with cholesterol for solubilization and the absorption site of the mixed micelles of the intestinal lumen , due to its structural similarities, which decreases the amount of cholesterol available for absorption. Another mechanism involved in this decrease is the modification in the expression of genes encoding the sterol transport proteins (NPC1-L1), reducing the transport of cholesterol to enterocytes, resulting in a lower esterification rate of cholesterol in the enterocyte and increased removal of this enterocyte of the body through the transintestinal excretion of cholesterol. Clinical studies have shown that the association of ingestion / supplementation of phytosterols with drug therapy with statins has significantly reduced LDL-C levels and can therefore be considered a good therapeutic strategy. Conclusion: The use of phytosterols by the ingestion of foods enriched with this compound and / or by means of supplementation had positive effects on the reduction of LDL-C and total cholesterol levels in subjects with hypercholesterolemia and low cardiovascular risk who have no indication of pharmacotherapy, or as an adjunct to pharmacological therapy in patients not responding to statins. Although few studies have demonstrated the direct relationship with the reduction of the risk for cardiovascular diseases, the decrease in plasma concentrations of LDL-c is already an important factor in reducing this risk. Keywords: Foods, dyslipidemia, phytosterols.