Cardiomiopatia chagásica e consumo de álcool: estudo do efeito combinado do etilismo sobre os níveis de biomarcadores cardíacos em doadores de sangue soropositivos e soronegativos para Trypanosoma cruzi

Abstract

Considered a neglected tropical disease, Chagas disease, for decades, was associated exclusively with the rural environment in endemic countries in Latin America, with the influence of social aspects of poverty. However, as a result of the dynamics and increase in the migratory flow of populations, Chagas disease has come to be considered a threat to global public health. It is estimated that between 6 and 8 million people are infected with Trypanosoma cruzi worldwide and 10,000 deaths occur annually, with another 70 million people at imminent risk of infection with T. cruzi. Chagas cardiomyopathy is considered one of the most serious chronic complications of Chagas disease, characterized as a variable heart disease, because it has multiple manifestations, there are gaps in knowledge and elucidation of pathophysiological aspects of Chagas cardiomyopathy. Alcohol consumption is widely identified as a risk factor for cardiovascular diseases, however, in relation to Chagas cardiomyopathy, the implications of alcohol consumption in the course of the disease, has gaps. The objective of this work was to evaluate the combined effect of alcohol consumption in relation to Chagas cardiomyopathy and the differences in the levels of cardiac biomarkers of seropositive and seronegative blood donors for T. cruzi. Two studies were developed. In the first study, an integrative literature review was carried out to report the various biomarkers described for Chagas cardiomyopathy, describing the clinical and pathophysiological significance in different contexts, isolated or combined, diagnosis, prognosis, risk, outcome, validation and limitations, synthesizing and integrating the main scientific evidence available in the literature. Biomarkers BNP, NT-proBNP, Troponin, CKMB, with evidence related to severity and risk in Chagas cardiomyopathy, already known, showed consistent associations. MMP-2, MMP-9, TIMP-1 and TIMP-2, TNF-α, IL-6, IL-8, IL-10 showed significant associations. Galectin-3, vimentin, 8-OHdG, copeptin, endostatin, hnRNPA1, DHEA-S, cystatin C, also with significant associations and perspectives for new approaches. In the second study, a cross-sectional study was carried out presenting data from the retrospective cohort study of theNational Heart Lung and Blood Institute (NHLBI) Retrovirus Epidemiology Donor Study-II (REDS-II), with 1088 blood donor patients, seeking to evaluate the combined effect of alcohol consumption in relation to chagasic cardiomyopathy and differences in levels of cardiac biomarkers. Most of the results show a significant relationship between the combined effect of alcohol consumption, Chagas cardiomyopathy and cardiac biomarkers, allowing the association of these patients with a risk condition. In the relationship between alcohol consumption and chagasic cardiomyopathy, NT-proBNP clearly indicates the association. In the alcohol consumption and cardiac biomarker ratio, NT-proBNP has greater power to identify differences, being present: (i) in the condition of alcohol consumption and the biomarker, (ii) amount of alcohol ingested, (iii) associated with serology, and (iv) in the combination of high quantity and frequency of alcohol consumption. Other biomarkers that are altered in the presence of alcoholism are: PAI-1, CK-MB and Adponectin. More studies are needed to evaluate the effect of alcohol on Chagas cardiomyopathy, considering the different cardiac biomarkers and clinical indicators.