Vinícius Cooper Capetini, Angela C Bersch-Ferreira, Annie Seixas Bello Moreira, Rachel Helena V Machado, Marcelo Macedo Rogero, Aline Marcadenti, Josefina Bressan, Renato Hideo N Santos, Cristiane Kovacs Amaral
Journal: Archives of endocrinology and metabolism 2025;69(1):e240373
PMID: 40130572
People who have already had heart disease are at high risk of experiencing another cardiovascular event. Managing blood fats (lipids) is an important part of preventing further problems. While cholesterol levels are commonly measured, proteins that transport fats in the bloodstream (apolipoproteins) may provide additional information about heart disease risk. However, less is known about how structured dietary programmes affect these markers in people who already have cardiovascular disease. This study aimed to evaluate whether the Brazilian Cardioprotective Nutrition Program (BALANCE Program) could improve apolipoproteins and lipid levels in adults with established cardiovascular disease. It was an exploratory analysis of 276 participants.
The results showed that participants in the BALANCE Program had no significant changes in apolipoprotein concentrations. However, significant reductions in total cholesterol and non-high density lipoprotein cholesterol.
In conclusion, a structured cardioprotective nutritional programme had no effect on plasma apolipoproteins. Healthcare professionals may use this evidence to understand that certain nutrition programmes may have limited effects on apolipoprotein concentrations.
OBJECTIVE
This study aimed to evaluate the impact of the Brazilian Cardioprotective Nutrition Program (BALANCE Program) on the plasma levels of various apolipoproteins (A-I, A-II, B, C-II, C-III, and E) and lipid biomarkers over a three-year follow-up period in individuals undergoing secondary cardiovascular prevention.
SUBJECTS AND METHODS
This exploratory analysis included 276 patients aged 45 years or older with a history of cardiovascular disease within the preceding decade. Participants were randomly assigned to one of two groups and monitored over three years: the BALANCE Program group (intervention group; n = 123) and the control (conventional nutritional advice; n = 153). Assessments of clinical and lifestyle data, anthropometry, food intake, plasma apolipoproteins, and lipid profiles were conducted at baseline and at the 3-year follow-up. Intervention adherence was measured utilizing the BALANCE dietary index.
RESULTS
By the end of the follow-up period, adherence was significantly higher in the intervention group (mean difference BALANCE-control [95% CI]: 2.09 points [-0.19; 4.37]), mainly due to increased consumption of fruits, vegetables, legumes, and low-fat dairy products. There were no significant differences in plasma apolipoprotein levels between the groups throughout the study. Nevertheless, significant reductions were observed in the total cholesterol and non-HDL cholesterol levels in the BALANCE group compared to the control group (mean difference intervention-control [95% CI]: -9.95 mg/dL [-18.5; -1.39] and -8.86 mg/dL [-17.53; -0.2], respectively).
CONCLUSION
Following three years of intervention, despite higher adherence to the BALANCE Program, there were no significant changes in plasma apolipoprotein concentrations or overall lipid biomarkers.
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