Influencia de la administración de L-carnitina sobre factores de riesgo cardiovasculares en una población geriátrica

Résumé

ABSTRACT Cardiovascular disease is the leading cause of morbidity and mortality worldwide, responsible for a public health spending that compromises the viability of health systems even in Western countries. Its incidence will continue to grow in the coming decades due to the aging world population. The development of cardiovascular disease is promoted by risk factors, especially hypertension, diabetes mellitus and dyslipidemia. Therefore, this PhD thesis aimed to study the effect of L-carnitine (LC) on blood pressure, blood glucose and lipid profile in a geriatric population. Thirty-three institutionalized subjects, divided into two groups, placebo and LC, with similar characteristics, were selected and given two grams of oral LC a day for four consecutive months. Three medical visits were made: at baseline, at two and four months. In each, an individual interview was conducted and anthropometric measurements and blood pressure were recorded, a questionnaire on adverse effects was filled in and a blood extraction was performed with determination of total and free LC, blood glucose and glycated hemoglobin, lipid profile (cholesterol, LDL and HDL fractions, triglyceride), parameters of renal function, blood count and ferrokinetics, proteins, albumin and C-reactive protein. Regarding the results of LC, it was observed that the plasma oscillations of free and total LC increased or decreased in a parallel evolution. In addition, women had a higher concentration of both when compared to men and the LC group in the fourth month, obtaining better levels than the placebo group. At the end of the study, subjects initially deficient in free and Total LC receiving the supplements had normalized levels. During monitoring of the the variables, trends were able to be defined in most cases, whilst significant differences were found only in a few. With respect to cardiovascular risk factors in the LC group, a tendency of weight gain and a better result in the systolic blood pressure was observed. However, there was worse glycemic control, especially in women, becoming significant from baseline to study completion and among women belonging to both groups at the end of the study. This was correlated with a significant worsening of glycosylated hemoglobin by group and sex, between the beginning and the end, and among women of both groups at the 4th month. In the lipid profile, the HDL fraction did improve significantly in the supplemented group and there were no significant changes in CT, LDL and TG. In all other biochemical parameters, a significant improvement in creatinine levels at the conclusion of the study in LC group and among women in both groups was detected. With respect to hemoglobin, it dropped significantly at the 4th month in women of the LC group and men of both groups. Regarding to iron metabolism, protein and C-reactive protein, no significant changes were observedexcept for albumin in women of the LC group at the 4th month. As a general conclusion it can be stated that oral supplementation of LC may be beneficial in situations where its' deficiency es demonstrated or expected, such as in a geriatric population where the prevalence is negatively motivated by comorbidities of the elderly. Moreover, it could be recommended to patients with hypertension, added to their conventional treatment and in situations where the concentration of HDL is decreased. It could also be suggested in situations of malnutrition, for gain weight and to improveprotein and albumin levels, as well as in situations with inflammatory activity (for the antioxidant capacity). These recommendations for carnitine can be safely set at a dose of 2 g per day, as the subjects studied tolerated their intake well, with few adverse effects.