De Michele Mario, Panico Salvatore, Iannuzzi Arcangelo, Celentano Egidio, Ciardullo Anna V, Galasso Rocco, Sacchetti Lucia, Zarrilli Federica, Bond M Gene, Rubba Paolo
Departments of Clinical and Experimental Medicine, Federico II, University, Naples, Italy.
Stroke. 2002 Dec;33(12):2923-8. doi: 10.1161/01.str.0000038989.90931.be.
The association between obesity and atherosclerotic disease is controversial. In the present analysis, we evaluated whether common carotid intima-media thickness (IMT) and area, 2 markers of preclinical atherosclerosis, were increased in obese subjects.
More than 5000 middle-aged women (n=5062; age, 30 to 69 years) living in the area of Naples, Southern Italy, were recruited for a prospective, currently ongoing study on the etiology of cardiovascular disease and cancer in the female population (the Progetto ATENA study). A subsample of 310 participants underwent high-resolution B-mode ultrasound examination, and the IMTs, intima-media areas, and lumen diameters of common carotid arteries were measured with a semiautomated computerized program. Subjects were divided into 3 groups on the basis of the recently published obesity guidelines for body mass index (BMI), a marker of general obesity, and tertiles of waist-to-hip ratio (WHR), a marker of regional obesity.
Women with a BMI >/=30 kg/m(2) showed higher systolic and diastolic blood pressures, triglycerides, and fasting glucose and insulin, as well as lower high-density lipoprotein concentrations, than subjects with lower BMI. A gradual increase in common carotid IMT and intima-media area was observed when lean women (0.94+/-0.01 mm and 19.8+/-0.5 mm(2), respectively) were compared with overweight (0.98+/-0.01 mm and 21.0+/-0.4 mm(2)) and obese (1.02+/-0.02 mm and 22.6+/-0.8 mm(2), P<0.005 for linear trend) individuals. Similarly, women in the highest tertile of WHR (>0.85) had adverse risk factor profiles and thicker carotid intima-media complex than those in the first 2 tertiles (P<0.01 and P<0.05 for IMT and intima-media area, respectively). In multivariate analyses, BMI and WHR were significant predictors of carotid wall thickness, independently of other traditional and nontraditional cardiovascular risk factors (age, blood pressure, lipid abnormalities, fasting insulin).
The present results indicate a graded and independent association between general and abdominal obesity-reflected by high BMI and WHR-and carotid artery wall thickening in a population of middle-aged women.
肥胖与动脉粥样硬化疾病之间的关联存在争议。在本分析中，我们评估了肥胖受试者的颈总动脉内膜中层厚度（IMT）和面积（临床前期动脉粥样硬化的两个标志物）是否增加。
居住在意大利南部那不勒斯地区的5000多名中年女性（n = 5062；年龄30至69岁）被纳入一项关于女性人群心血管疾病和癌症病因的前瞻性、正在进行的研究（阿蒂娜项目研究）。310名参与者的子样本接受了高分辨率B型超声检查，并用半自动计算机程序测量颈总动脉的IMT、内膜中层面积和管腔直径。根据最近发布的肥胖指南中关于体重指数（BMI，一般肥胖的标志物）以及腰臀比（WHR，局部肥胖的标志物）的三分位数，将受试者分为3组。
BMI≥30 kg/m²的女性与BMI较低的受试者相比，收缩压和舒张压、甘油三酯、空腹血糖和胰岛素水平更高，高密度脂蛋白浓度更低。将瘦女性（IMT分别为0.94±0.01 mm，内膜中层面积为19.8±0.5 mm²）与超重（IMT为0.98±0.01 mm，内膜中层面积为21.0±0.4 mm²）和肥胖（IMT为1.02±0.02 mm，内膜中层面积为22.6±0.8 mm²，线性趋势P<0.005）个体进行比较时，观察到颈总动脉IMT和内膜中层面积逐渐增加。同样，WHR最高三分位数（>0.85）的女性与前两个三分位数的女性相比，具有不良风险因素谱且颈动脉内膜中层复合体更厚（IMT和内膜中层面积分别P<0.01和P<0.05）。在多变量分析中，BMI和WHR是颈动脉壁厚度的显著预测因素，独立于其他传统和非传统心血管危险因素（年龄、血压、血脂异常、空腹胰岛素）。
目前的结果表明，在中年女性人群中，由高BMI和WHR反映的一般肥胖和腹部肥胖与颈动脉壁增厚之间存在分级且独立的关联。
