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El fenotipo metabólico completo refina el riesgo cardiovascular en adultos jóvenes
Venkatesh L Murthy1, Jared P Reis2, Alexander R Pico3
1Departments of Medicine and Radiology, University of Michigan, Ann Arbor (V.L.M.).
Circulation
|October 19, 2020
Resumen
Los perfiles metabólicos en adultos jóvenes predicen el riesgo de enfermedad cardiovascular (ECV) décadas más tarde. Estas firmas metabólicas identifican las vías tempranas de ECV y ayudan a la estratificación del riesgo para la prevención.
Área de la Ciencia:
- Metabolomía
- Investigación de las enfermedades cardiovasculares
- Medicina de precisión
Sus antecedentes:
- El riesgo de enfermedad cardiovascular (ECV) generalmente se evalúa en personas mayores de 40 años, sin embargo, las lesiones tempranas de ECV se desarrollan mucho antes.
- Los fenotipos de riesgo metabólico precisos en poblaciones biraciales más jóvenes siguen siendo poco estudiados, a pesar del papel del metabolismo en el desarrollo de ECV.
Objetivo del estudio:
- Identificar perfiles de metabolitos en adultos jóvenes asociados con fenotipos adversos de enfermedad cardiovascular (ECV) y resultados a largo plazo.
- Explorar los mecanismos subyacentes y validar las puntuaciones de riesgo basadas en metabolitos en cohortes independientes.
Principales métodos:
- Análisis de 2330 adultos jóvenes del estudio CARDIA (Desarrollo del riesgo de la arteria coronaria en adultos jóvenes) utilizando aprendizaje estadístico y regresión de Cox.
- Desarrollo y validación de las puntuaciones de riesgo basadas en metabolitos en el Framingham Heart Study.
Principales resultados:
- Los perfiles metabólicos en la edad adulta temprana predijeron el desarrollo subclínico de ECV durante 20 años, revelando nuevas vías de ECV.
- Dos puntuaciones basadas en metabolitos vinculados independientemente a la salud vascular y miocárdica, asociadas con ECV clínica durante ~ 25 años.
- Los hallazgos se replicaron en el Framingham Heart Study, mostrando asociaciones similares y una mejor predicción del riesgo de ECV, especialmente en individuos más jóvenes.
Conclusiones:
- Las firmas metabólicas en la edad adulta joven identifican las vías clave de disfunción metabólica relevantes para la ECV.
- Estas firmas están asociadas con resultados cardiovasculares a largo plazo en cohortes independientes.
- La integración de medidas de salud metabólica de precisión en la estratificación del riesgo es crucial para la intervención temprana de ECV.
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