Efeito da suplementação de probióticos sobre a força muscular após a revascularização miocárdica: um ensaio clínico randomizado, controlado e triplo cego

Abstract

Coronary artery disease (CAD) is an inflammatory condition triggered by non-modifiable and modifiable risk factors. Evidence suggests that quantitative and/or functional imbalance of the intestinal microbiota perfomance a significant role in the pathogenesis of this disease, which is associated with inflammatory disorders that can cause metabolic and immunological disorders, with muscular repercussions. In this context, the use of probiotics as adjuvant therapy in cardiovascular diseases has been investigated, aiming to reduce the pro-inflammatory state. However, the effect of probiotics on muscle strength in humans is still poorly understood. This study aims to investigate the effect of probiotic supplementation on handgrip strength in individuals undergoing myocardial revascularization. This is a randomized, parallel-arm, placebo-controlled, triple-blind clinical trial targeting adults and elderly individuals of both sexes after coronary artery bypass grafting due to acute myocardial infarction with ST-segment elevation in a cardiovascular referral hospital in the city of Dourados-MS. Participants were randomized into intervention groups (Lacticaseibacillus paracasei CCT 7861, Lacticaseibacillus rhamnosus CCT 7863, Lacticaseibacillus acidophilus CCT 7947, Bifidobacterium lactis CCT 7858) and control groups (placebo: maltodextrin), supplemented for 12 weeks. Data collection included the application of a questionnaire containing sociodemographic and clinical data at baseline, assessment of muscle strength (primary outcome), anthropometric indicators (secondary outcomes), gastrointestinal symptoms, stool shape and consistency, physical activity level, and current dietary intake at both study time points. For all analyses, the significance level adopted was 5%. This study was registered on the online platform “Brazilian Registry of Clinical Trials (ReBEC)”. Identification: RBR6ztyb7. A total of 45 participants of both sexes participated in the research (probiotic: 22 and placebo: 23). The majority were male (73.3%), elderly (57.8%), current smokers (66.7%), and with known previous cardiovascular diseases (48.8%). No significant differences were identified between the groups at baseline and final time points for any of the characterization variables, including physical activity level, dietary intake, and anthropometric indicators. After 90 days of supplementation, handgrip strength (HGS) did not show significant differences between groups, considering the entire sample. Likewise, adherence to supplementation was similar among participants (p = 0.990), with no reports of adverse effects. However, when specifically analyzing the subgroup of men aged 50 years or older, classified as having low HGS at baseline (probiotic: n = 14; placebo: n = 16), a significant increase in HGS was observed in the intervention group compared to the placebo group after the supplementation period (mean difference: 4,6 kgf; p = 0.044). In conclusion, in the analysis involving the entire sample, there were no significant differences. However, probiotic supplementation for 90 days increased muscle strength in the non-dominant hand in men aged 50 years or older with low muscle strength, after myocardial revascularization surgery.