Abstract
Introduction: In the metabolomics scenario of obesity and cardiovascular disease, epitranscriptomics establishes a novel mechanism of post-transcriptional RNA regulation. There is growing evidence supporting the role of intra- and extracellular microRNAs (miRNAs) as determinants of cross-talk between adipose tissue, liver, skeletal muscle, and other organs, triggering paracrine communication between different tissues. Objective: To describe, through a systematic literature review, the main approaches to metabolomics of microRNAs and exosomes in cardiovascular disease in obese patients. Methods: The systematic review guidelines of the PRISMA Platform were followed. The search was conducted from March to May 2025 across the Web of Science, Scopus, Embase, PubMed, ScienceDirect, Scielo, and Google Scholar databases. Study quality was based on the GRADE instrument, and risk of bias was analyzed according to the Cochrane tool. Results and Conclusion: A total of 121 articles were found. A total of 18 articles were fully evaluated, and 9 were included and developed in this systematic review. Considering the Cochrane risk of bias tool, the overall assessment resulted in 32 studies with a high risk of bias and 21 studies that did not meet the GRADE and AMSTAR-2 criteria. Most studies presented homogeneity in their results, with X2=91.4%>50%. It was concluded that the decrease in circulating miR-19 levels during dietary interventions for weight loss was associated with a significant reduction in the risk of atherosclerotic cardiovascular disease. Epicardial adipose tissue-derived miRNAs exert paracrine effects on the human heart. Epicardial adipose tissue-derived miR-92a-3p is associated with improved clinical outcomes and is a therapeutic target for the prevention and treatment of obesity-related heart disease. An increased profile of plasma miR-126-3p was identified in hypertensive patients with albuminuria. The Mediterranean diet better modulates endothelial function compared to a low-fat diet. Therefore, the potential of microRNAs, particularly miR-133b and miR-126, is postulated as diagnostic biomarkers to distinguish patients with ST-segment elevation from those with non-ischemic chest discomfort.