Efeito da suplementação de probióticos sobre marcadores metabólicos e imunoinflamatórios após a revascularização miocárdica: ensaio clínico randomizado, controlado e triplo-cego

Abstract

Coronary artery disease (CAD) is a chronic inflammatory condition and remains the leading cause of cardiovascular morbidity and mortality. Scientific evidence suggests that gut dysbiosis plays a significant role in the pathogenesis of this disease. In this context, probiotics have emerged as a potential adjuvant treatment in various metabolic disorders due to their beneficial effects on gut microbiota modulation, metabolic profile improvement, and intestinal barrier strengthening. However, their effects following myocardial revascularization, with the aim of improving metabolic and immunological parameters, have not yet been explored. This study investigated the impact of probiotic supplementation on inflammatory and metabolic responses of patients undergoing coronary artery bypass grafting (CABG). This was a randomized, placebo-controlled, triple-blind clinical trial with parallel arms, involving adult and elderly patients of both sexes who underwent CABG after ST-segment elevation myocardial infarction (STEMI), conducted at a tertiary referral cardiovascular hospital in Dourados, Mato Grosso do Sul, Brazil. Participants were randomized into an intervention group (Lacticaseibacillus paracasei CCT 7861, Lacticaseibacillus rhamnosus CCT 7863, Lacticaseibacillus acidophilus CCT 7947, and Bifidobacterium lactis CCT 7858) and a control group (maltodextrin), both for a period of 90 days. Data collection occurred at two time points and included a questionnaire with sociodemographic and clinical information at baseline, as well as the collection of biological samples for biochemical analysis. Primary outcomes included C-reactive protein, total cholesterol and its fractions, and fasting glucose. Secondary outcomes included a complete blood count. Multivariate linear regression analyses were performed considering the outcomes as dependent variables, with a significance level set at 5%. This clinical trial was registered on the Brazilian Clinical Trials Registry (ReBEC) under the identifier RBR6ztyb7. A total of 45 individuals were analyzed (placebo: 22; intervention: 23), the majority being male (73.3%), elderly (57.8%), current smokers (66.7%), and with known previous cardiovascular diseases (48.8%). No statistically significant differences were found between the groups after supplementation. Multivariate linear regression analyses did not identify significant associations between probiotic intake and the outcomes evaluated. Although the models explained part of the variability, no significant effects of probiotic use were observed. Adherence to supplementation was above 98% in both groups, and no adverse events were reported. In conclusion, 90-day probiotic supplementation did not reduce serum levels of metabolic or immunoinflammatory markers in patients undergoing CABG after STEMI.