Division of Cardiovascular Surgery, Department of Surgery, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City 231, Taiwan.
School of Medicine, Tzu Chi University, Hualien 970, Taiwan.
Int J Mol Sci. 2020 Aug 31;21(17):6294. doi: 10.3390/ijms21176294.
Cardiovascular disease (CVD) is closely related to chronic kidney disease (CKD), and patients with CKD have a high risk of CVD-related mortality. Traditional CVD risk factors cannot account for the higher cardiovascular risk of patients with CKD, and standard CVD interventions cannot reduce the mortality rates among patients with CKD. Nontraditional factors related to mineral and vitamin-D metabolic disorders provide some explanation for the increased CVD risk. Non-dialyzable toxins, indoxyl sulfate (IS) and -cresol sulfate (PCS)-produced in the liver by colonic microorganisms-cause kidney and vascular dysfunction. Plasma trimethylamine-N-oxide (TMAO)-a gut microbe-dependent metabolite of dietary L-carnitine and choline-is elevated in CKD and related to vascular disease, resulting in poorer long-term survival. Therefore, the modulation of colonic flora can improve prospects for patients with CKD. Managing metabolic syndrome, anemia, and abnormal mineral metabolism is recommended for the prevention of CVD in patients with CKD. Considering nontraditional risk factors, the use of resveratrol (RSV), a nutraceutical, can be helpful for patients with CVD and CKD. This paper discusses the beneficial effects of RSV on biologic, pathophysiological and clinical responses, including improvements in intestinal epithelial integrity, modulation of the intestinal microbiota and reduction in hepatic synthesis of IS, PCS and TMAO in patients with CVD and CKD.
心血管疾病(CVD)与慢性肾脏病(CKD)密切相关,CKD 患者的 CVD 相关死亡率较高。传统的 CVD 危险因素不能解释 CKD 患者更高的心血管风险,标准的 CVD 干预措施也不能降低 CKD 患者的死亡率。与矿物质和维生素 D 代谢紊乱相关的非传统因素为 CVD 风险增加提供了一些解释。非透析性毒素、由肠道微生物在肝脏产生的吲哚硫酸(IS)和 - 甲苯硫酸(PCS)——导致肾脏和血管功能障碍。血浆三甲胺 N-氧化物(TMAO)——膳食肉毒碱和胆碱的肠道微生物依赖性代谢物——在 CKD 中升高,与血管疾病相关,导致长期生存状况较差。因此,调节结肠菌群可以改善 CKD 患者的前景。建议管理代谢综合征、贫血和异常矿物质代谢,以预防 CKD 患者的 CVD。考虑到非传统危险因素,使用营养保健品白藜芦醇(RSV)对 CVD 和 CKD 患者可能有帮助。本文讨论了 RSV 对生物、病理生理和临床反应的有益作用,包括改善肠道上皮完整性、调节肠道微生物群以及减少 CVD 和 CKD 患者肝脏中 IS、PCS 和 TMAO 的合成。