Karason K, Wikstrand J, Sjöström L, Wendelhag I
Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden.
Int J Obes Relat Metab Disord. 1999 Sep;23(9):948-56. doi: 10.1038/sj.ijo.0801024.
To investigate the extent of carotid artery atherosclerosis in obese subjects and to examine the possible effects of weight loss on atherosclerotic development.
Controlled 4 y intervention study.
20 obese patients treated with weight-reducing gastroplasty, 19 obese patients treated with dietary recommendations and 35 lean subjects.
Body weight, blood pressure, blood lipids, glucose and insulin were measured. A B-mode ultrasound was recorded to determine the intima-media thickness (IMT) and lumen diameter (LD) of the carotid artery. Study groups were investigated at baseline and re-examined after 3 to 4 y of follow-up.
At baseline, obese patients had higher blood pressure, serum total cholesterol, triglycerides, glucose and insulin compared with lean subjects; they also had a larger IMT in the carotid artery bulb (P<0.05) and a larger LD in the common carotid artery (P<0.01). After 4 y of follow-up, obese patients treated with surgery displayed a mean weight loss of 22 kg (19%), while the average weight in the obese control group remained unchanged (P<0.001). The weight loss group showed improvements in blood pressure, HDL-cholesterol, triglycerides and insulin compared with the obese control group (P<0.05). The progression rate of carotid bulb IMT in the weight loss group was similar to that observed in the lean control group (0.024 vs 0.025 mm/y, n.s.), whereas the IMT progression rate was almost three times higher in the obese control group (0.068 mm/y, P<0.05 compared with lean controls).
Obese people have an unfavourable risk factor profile and signs of premature carotid artery atherosclerosis. Weight loss is followed by an improvement in several risk factors and may reduce the progression rate of atherosclerotic changes in the carotid artery bulb.
研究肥胖受试者颈动脉粥样硬化的程度，并探讨体重减轻对动脉粥样硬化发展的可能影响。
4年对照干预研究。
20例接受减重胃成形术的肥胖患者、19例接受饮食建议治疗的肥胖患者和35例瘦素正常受试者。
测量体重、血压、血脂、血糖和胰岛素。记录B型超声以确定颈动脉的内膜中层厚度（IMT）和管腔直径（LD）。在基线时对研究组进行调查，并在随访3至4年后重新检查。
基线时，肥胖患者的血压、血清总胆固醇、甘油三酯、血糖和胰岛素水平均高于瘦素正常受试者；他们在颈动脉窦处的IMT也更大（P<0.05），在颈总动脉处的LD更大（P<0.01）。随访4年后，接受手术治疗的肥胖患者平均体重减轻22kg（19%），而肥胖对照组的平均体重保持不变（P<0.001）。与肥胖对照组相比，体重减轻组的血压、高密度脂蛋白胆固醇、甘油三酯和胰岛素水平有所改善（P<0.05）。体重减轻组颈动脉窦IMT的进展率与瘦素正常对照组相似（分别为0.024和0.025mm/年，无显著差异），而肥胖对照组的IMT进展率几乎高出三倍（0.068mm/年，与瘦素正常对照组相比P<0.05）。
肥胖人群具有不良的危险因素谱和颈动脉过早出现动脉粥样硬化的迹象。体重减轻后，多种危险因素得到改善，可能会降低颈动脉窦动脉粥样硬化变化的进展率。
