INTRODUÇÃO: Aventa-se a hipótese de quepacientes com endometriose poderiam apresentar risco elevado para doenças cardiovasculares. Existe, porém, controvérsia quanto ao perfil lipídico observado nessas pacientes. OBJETIVOS: avaliar os marcadores de risco cardiovascular associados à endometriose, comparando-se o efeito sobre eles de dois diferentes tratamentos para esta doença: Sistema Intra-uterino liberador de levonorgestrel (SIU-LNG) e o análogo do GnRH na forma de depósito (aGnRH). Marcadores inflamatórios, parâmetros clínicos e avaliação lipídica foram utilizados como marcadores de risco cardiovascular. MATERIAL E MÉTODOS: Quarenta pacientes entre 18 e 40 anos, com diagnóstico laparoscópico de endometriose, foram randomizadas para receber tratamento com SIU-LNG (n=22) e com o aGnRH (n=18), durante 6 meses. Foram avaliados o índice de massa corporal, a freqüência cardíaca, as pressões arteriais sistólica e diastólica, além dos seguintes parâmetros laboratoriais: lipidograma (colesterol total (CT), HDL-colesterol (HDL-C), LDL-colesterol (LDL-C), triglicérides (TGL)), interleucina-6 (IL-6), proteína C reativa (PCR), homocisteína, molécula de adesão decélula vascular (VCAM), fator de necrose tumoral ?(TNF-?) e contagem de leucócitos (LCT), sendo realizados no início e após seis meses de tratamento. RESULTADOS: no grupo do SIU-LNG, houve redução dos níveis do VCAM (92,8 ± 4,2ng/mL para 91,2 ± 2,7ng/mL, p=0,04), PCR (0,38 ± 0,30mg/dL para 0,28 ± 0,21mg/dL, p=0,03), CT (247,0 ± 85,0 mg/dL para 180,0 ± 31,0 mg/dL, p=0,0002), TGL (118,0 ± 76,0 mg/dL para 86,5 ± 41,5 mg/dL,p=0,003), LDL-C (160,5 + 66,0mg/dL para 114,5 + 25,5mg/dL, p=0,0005) e HDL-C (63,0 + 20,5mg/dL para 48,5 + 10,5mg/Dl, p=0,002). No grupo do aGnRH, houve aumento da homocisteína (11,5 + 2,9 µmol/L para 13,0 + 2,7µmol/L, p=0,04) e diminuição dos níveis de IL-6 (4,3 + 3,9pg/mL para 2,3 + 0,8pg/mL, p=0,005), VCAM (94,0 + 3,8ng/mL para 92,0 + 1,6ng/mL, p=0,03) e LCT (7330 + 2554 para 6350 + 1778, p=0,01). Esse estudo mostra que alguns marcadores de risco cardiovascular são influenciados por ambos aGnRH e SIU-LNG, mas esse último reduz mais os níveis lipídicos e pode ter efeitos mais favoráveis em longo prazo. / The aim of this prospective and controlled study was to evaluate the cardiovascular risk markers associated with endometriosis and the influence of the levonorgestrel intra-uterine system (LNG-IUS) compared with the GnRH analogue (GnRHa) leuprolide acetate on these risks after six monthsof treatment. Methods: This was a randomized, prospective, open clinical study, with44 patients with laparoscopically and histologically confirmed endometriosis. Patients were randomized into two groups: LNG-IUS group, 22 patients submittedto LNG-IUS insertion, and GnRHa group, 22 patients who received a monthly GnRHa injection for six months. Body mass index, systolic and diastolic arterial blood pressure, heart rate and laboratory cardiovascular risk markers such as interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-alpha), C-reactive protein (CRP), homocysteine (HMC), lipid profile, total leucocytes, and vascular cell adhesion molecule (VCAM) were measured before and six months after treatment. Results: in the LNG-IUS group, there was reduction of the levels of VCAM(92.8 +4.2 to 91.2+2.7 ng/mL, p = 0.04), CRP (0.38+0.30 to 0.28+0.21 mg/dL, p = 0.03), total cholesterol (247.0+85.0 to 180.0+31.0 mg/dL, p = 0.0002), triglycerides (118.0+ 76.0 to 86.5+41.5 mg/dL, p = 0.003), LDL (160.5+66.0 to 114.5+25.5 mg/dL, p = 0.0005) and HDL (63.0+20.5 to 48.5+10.5 mg/dL, p = 0.002). The GnRHa group showed an increase of HMC levels (11.5+2.9 to 13.0+2.7 µmol/L, p = 0.04) and a reduction of IL-6 levels (4.3+3.9 to 2.3+0.8 pg/mL, p = 0.005), VCAM (94.0+3.8 to 92.0+1.6 ng/mL, p = 0.03) and total leucocytes (7330+2554 to 6350+1778, p = 0.01). Conclusions: This study shows that some cardiovascular risk markers are influenced by both GnRHa and LNG-IUS,but the latter had a greater positive impact on the lipid profile, which could lead to a favorable effect during long-term treatment.

INTRODUÇÃO: Aventa-se a hipótese de quepacientes com endometriose poderiam apresentar risco elevado para doenças cardiovasculares. Existe, porém, controvérsia quanto ao perfil lipídico observado nessas pacientes. OBJETIVOS: avaliar os marcadores de risco cardiovascular associados à endometriose, comparando-se o efeito sobre eles de dois diferentes tratamentos para esta doença: Sistema Intra-uterino liberador de levonorgestrel (SIU-LNG) e o análogo do GnRH na forma de depósito (aGnRH). Marcadores inflamatórios, parâmetros clínicos e avaliação lipídica foram utilizados como marcadores de risco cardiovascular. MATERIAL E MÉTODOS: Quarenta pacientes entre 18 e 40 anos, com diagnóstico laparoscópico de endometriose, foram randomizadas para receber tratamento com SIU-LNG (n=22) e com o aGnRH (n=18), durante 6 meses. Foram avaliados o índice de massa corporal, a freqüência cardíaca, as pressões arteriais sistólica e diastólica, além dos seguintes parâmetros laboratoriais: lipidograma (colesterol total (CT), HDL-colesterol (HDL-C), LDL-colesterol (LDL-C), triglicérides (TGL)), interleucina-6 (IL-6), proteína C reativa (PCR), homocisteína, molécula de adesão decélula vascular (VCAM), fator de necrose tumoral ?(TNF-?) e contagem de leucócitos (LCT), sendo realizados no início e após seis meses de tratamento. RESULTADOS: no grupo do SIU-LNG, houve redução dos níveis do VCAM (92,8 ± 4,2ng/mL para 91,2 ± 2,7ng/mL, p=0,04), PCR (0,38 ± 0,30mg/dL para 0,28 ± 0,21mg/dL, p=0,03), CT (247,0 ± 85,0 mg/dL para 180,0 ± 31,0 mg/dL, p=0,0002), TGL (118,0 ± 76,0 mg/dL para 86,5 ± 41,5 mg/dL,p=0,003), LDL-C (160,5 + 66,0mg/dL para 114,5 + 25,5mg/dL, p=0,0005) e HDL-C (63,0 + 20,5mg/dL para 48,5 + 10,5mg/Dl, p=0,002). No grupo do aGnRH, houve aumento da homocisteína (11,5 + 2,9 µmol/L para 13,0 + 2,7µmol/L, p=0,04) e diminuição dos níveis de IL-6 (4,3 + 3,9pg/mL para 2,3 + 0,8pg/mL, p=0,005), VCAM (94,0 + 3,8ng/mL para 92,0 + 1,6ng/mL, p=0,03) e LCT (7330 + 2554 para 6350 + 1778, p=0,01). Esse estudo mostra que alguns marcadores de risco cardiovascular são influenciados por ambos aGnRH e SIU-LNG, mas esse último reduz mais os níveis lipídicos e pode ter efeitos mais favoráveis em longo prazo. / The aim of this prospective and controlled study was to evaluate the cardiovascular risk markers associated with endometriosis and the influence of the levonorgestrel intra-uterine system (LNG-IUS) compared with the GnRH analogue (GnRHa) leuprolide acetate on these risks after six monthsof treatment. Methods: This was a randomized, prospective, open clinical study, with44 patients with laparoscopically and histologically confirmed endometriosis. Patients were randomized into two groups: LNG-IUS group, 22 patients submittedto LNG-IUS insertion, and GnRHa group, 22 patients who received a monthly GnRHa injection for six months. Body mass index, systolic and diastolic arterial blood pressure, heart rate and laboratory cardiovascular risk markers such as interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-alpha), C-reactive protein (CRP), homocysteine (HMC), lipid profile, total leucocytes, and vascular cell adhesion molecule (VCAM) were measured before and six months after treatment. Results: in the LNG-IUS group, there was reduction of the levels of VCAM(92.8 +4.2 to 91.2+2.7 ng/mL, p = 0.04), CRP (0.38+0.30 to 0.28+0.21 mg/dL, p = 0.03), total cholesterol (247.0+85.0 to 180.0+31.0 mg/dL, p = 0.0002), triglycerides (118.0+ 76.0 to 86.5+41.5 mg/dL, p = 0.003), LDL (160.5+66.0 to 114.5+25.5 mg/dL, p = 0.0005) and HDL (63.0+20.5 to 48.5+10.5 mg/dL, p = 0.002). The GnRHa group showed an increase of HMC levels (11.5+2.9 to 13.0+2.7 µmol/L, p = 0.04) and a reduction of IL-6 levels (4.3+3.9 to 2.3+0.8 pg/mL, p = 0.005), VCAM (94.0+3.8 to 92.0+1.6 ng/mL, p = 0.03) and total leucocytes (7330+2554 to 6350+1778, p = 0.01). Conclusions: This study shows that some cardiovascular risk markers are influenced by both GnRHa and LNG-IUS,but the latter had a greater positive impact on the lipid profile, which could lead to a favorable effect during long-term treatment.