McGill Henry C, McMahan C Alex, Herderick Edward E, Zieske Arthur W, Malcom Gray T, Tracy Richard E, Strong Jack P
University of Texas Health Science Center at San Antonio, USA.
Circulation. 2002 Jun 11;105(23):2712-8. doi: 10.1161/01.cir.0000018121.67607.ce.
Obesity is a risk factor for adult coronary heart disease and is increasing in prevalence among youths as well as adults. Results regarding the association of obesity with atherosclerosis are conflicting, particularly when analyses account for other risk factors.
The Pathobiological Determinants of Atherosclerosis in Youth (PDAY) study collected arteries, blood, and other tissue from approximately 3000 persons aged 15 to 34 years dying of external causes and autopsied in forensic laboratories. We measured gross atherosclerotic lesions in the right coronary artery (RCA), American Heart Association (AHA) lesion grade in the left anterior descending coronary artery (LAD), serum lipid concentrations, serum thiocyanate (for smoking), intimal thickness of renal arteries (for hypertension), glycohemoglobin (for hyperglycemia), and adiposity by body mass index (BMI) and thickness of the panniculus adiposus. BMI in young men was associated with both fatty streaks and raised lesions in the RCA and with AHA grade and stenosis in the LAD. The effect of obesity (BMI>30 kg/m(2)) on RCA raised lesions was greater in young men with a thick panniculus adiposus. Obesity was associated with non-HDL and HDL (inversely) cholesterol concentrations, smoking (inversely), hypertension, and glycohemoglobin concentration, and these variables accounted for approximately 15% of the effect of obesity on coronary atherosclerosis in young men. BMI was not associated with coronary atherosclerosis in young women although there was trend among those with a thick panniculus adiposus.
Obesity is associated with accelerated coronary atherosclerosis in adolescent and young adult men. These observations support the current emphasis on controlling obesity to prevent adult coronary heart disease.
肥胖是成人冠心病的一个危险因素，在青少年和成年人中的患病率都在上升。关于肥胖与动脉粥样硬化之间关联的研究结果相互矛盾，尤其是在分析中考虑了其他危险因素时。
青少年动脉粥样硬化病理生物学决定因素（PDAY）研究从大约3000名15至34岁因外部原因死亡并在法医实验室进行尸检的人群中收集了动脉、血液和其他组织。我们测量了右冠状动脉（RCA）的大体动脉粥样硬化病变、左前降支冠状动脉（LAD）的美国心脏协会（AHA）病变分级、血清脂质浓度、血清硫氰酸盐（用于评估吸烟情况）、肾动脉内膜厚度（用于评估高血压）、糖化血红蛋白（用于评估高血糖），并通过体重指数（BMI）和皮下脂肪厚度评估肥胖程度。年轻男性的BMI与RCA中的脂肪条纹和隆起病变以及LAD中的AHA分级和狭窄均相关。在皮下脂肪厚的年轻男性中，肥胖（BMI>30 kg/m²）对RCA隆起病变的影响更大。肥胖与非高密度脂蛋白和高密度脂蛋白（呈负相关）胆固醇浓度、吸烟（呈负相关）、高血压和糖化血红蛋白浓度相关，这些变量约占肥胖对年轻男性冠状动脉粥样硬化影响的15%。年轻女性的BMI与冠状动脉粥样硬化无关联，尽管在皮下脂肪厚者中存在一定趋势。
肥胖与青少年及年轻成年男性冠状动脉粥样硬化加速相关。这些观察结果支持了当前对控制肥胖以预防成人冠心病的重视。
