Impacto das estatinas, alimentação saudável e exercícios físicos no controle das dislipidemias: uma revisão sistemática

Abstract

Introduction: Dyslipidemias are metabolic conditions associated with an increased risk of cardiovascular diseases, often treated with statins due to their proven efficacy in reducing lipid parameters. However, non-pharmacological approaches, such as specific diets and physical exercise, have shown potential in enhancing the benefits of statins or even serving as alternatives in certain contexts. The need to optimize treatment strategies for populations from different socioeconomic backgrounds underscores the importance of investigating the effectiveness of these interventions in an integrated manner. Objectives: To evaluate, through a systematic review, the isolated and combined effectiveness of statins, diet, and physical exercise in improving the lipid profile, with a focus on feasible recommendations for lower-middle-class populations. Methods: Following the PRISMA 2020 protocol, the Capes, PubMed, and SciELO databases were searched (January-February/2024). Inclusion criteria encompassed primary studies in English involving adult dyslipidemic humans, established interventions, and lipid index analysis. Data were extracted based on a checklist adapted from the Cochrane Handbook. Study quality was assessed using Impact Factor (IF) and Qualis, and risk of bias was evaluated using the adapted Robvis model from Cochrane. Results were synthesized using PICO elements. Results: The analysis of nine relevant studies showed that statins are the most effective isolated intervention for reducing lipid parameters, with LDL-C reductions reaching up to -32.5 ± 30.2 mg/dL (19.8%, p < 0.0001). The combinations of statins with physical exercise demonstrated even more significant effects on reducing plasma lipids, such as in the STAET group, which achieved substantial reductions in TC, TG, HDL, and LDL compared to isolated interventions (p ≤ 0.001). Dietary interventions, including nutraceuticals (LEVELIP DUO and monacolin K), also resulted in significant reductions in LDL-C and TC levels, with reductions ranging from 13% to nearly 20% (p < 0.0001), albeit with lesser efficacy than statins. Additionally, diets combined with time-restricted eating (TRE) of 10 hours reduced LDL-C by -11.94 ± 19.01 mg/dL (11%, p = 0.016) and TC by -13.16 ± 24.29 mg/dL (7%, p = 0.03). Physical exercise alone improved cardiorespiratory fitness, with a VO2 max increase of up to 20% (p = 0.001), and fat metabolism, but had limited impact on the lipid profile. Conversely, physical inactivity adversely affected the lipid profile, increasing TC by +6.8% and LDL-C by +15.8% (p < 0.01) and decreasing HDL-C by 3%, even among individuals undergoing statin and dietary therapy. Furthermore, approaches such as time-restricted eating (TRE) and intensive nutritional education programs proved effective, particularly in high cardiovascular risk populations, promoting significant improvements in the lipid profile. Conclusion: Statins are the most effective intervention for reducing lipid parameters, particularly when combined with physical exercise, which enhances the beneficial effects. Specific diets also demonstrated a positive impact, although less effective than statins. Physical exercise, while having a limited effect on the lipid profile, was found to be important for metabolism and cardiorespiratory fitness. In lower-middle-class populations, statins represent the most viable option due to cost-effectiveness, while combined approaches may offer additional advantages for patients with higher adherence and favorable economic conditions