Impacto de los metabolitos relacionados con el microbioma intestinal y el metabolismo mitocondrial sobre los eventos cardiovasculares tras un síndrome coronario agudo

Identificador:  TDX:4308

Handle: https://hdl.handle.net/20.500.11797/TDX4308

Autores:  Sánchez Giménez, Raúl

Resumen:
Patients who have experienced acute coronary syndrome are at significant risk of long-term adverse events. Identification of those most at risk is necessary to implement secondary prevention measures. The study of metabolic alterations in these patients can help provide relevant prognostic information during follow-up. Therefore, the objective of this doctoral thesis was to analyze the metabolic alterations associated with the intestinal and mitochondrial microbiota related to the occurrence of major cardiovascular events during follow-up in patients admitted for acute coronary syndrome. The doctoral thesis consists of three studies. In the first study, a systematic review of metabolites related to the gut microbiome and its relationship to cardiovascular disease was performed. In the second study, conducted in patients with acute coronary syndrome followed up long-term, it was shown that subjects with altered plasma concentrations of metabolites derived from intestinal flora had an increased risk of major adverse cardiovascular events during follow-up. The same results were obtained in the third study conducted in the same cohort of patients, where the relationship between metabolites derived from mitochondrial dysfunction and cardiovascular events during follow-up was studied. In both observational studies, an important mediation of this effect was obtained due to the deterioration of renal function. Therefore, the research carried out supports the study of the metabolome and these mentioned metabolic pathways in cardiovascular disease. The metabolites derived from the intestinal microbiota and those derived from mitochondrial dysfunction could be used as markers that provide valuable prognostic information in patients with acute coronary syndrome. The identification of patients with the highest risk could optimize the design of more intensive therapeutic strategies and discover possible new metabolic pathways to which to target new therapeutic weapons in the high rate of major cardiovascular adverse events associated with these diseases.