Brook Robert D
Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI, USA.
Endocrine. 2006 Feb;29(1):21-5. doi: 10.1385/endo:29:1:21.
Obesity promotes the development of several major cardiovascular risk factors. Moreover, excess adiposity may play a direct role in initiating atherosclerosis as fat cells are capable of affecting the systemic vasculature through a variety of mechanisms. Recent studies demonstrate that obesity per se may impair vascular endothelial function. This is important as endothelial dysfunction is a key factor in the pathogenesis of atherosclerosis and in triggering acute ischemic events. At present, few studies have determined the beneficial impact of weight loss on cardiovascular outcomes and mortality. However, several experiments have demonstrated that weight loss can lead to improvements in endothelial function, a validated surrogate marker of cardiovascular risk. The mechanisms whereby weight loss restores vascular health are likely multifactorial. However, the relative importance of reduced adiposity versus the specific dietary regimens prescribed, the role of concomitant exercise, and the direct effect of medications remain unclear. Several other unresolved issues such as the longevity of improvement, the amount of weight loss required, and whether the improvement in endothelial function actually translates into a reduction in cardiovascular events also remain to be determined. Nevertheless, lifestyle changes that lead to weight reduction are able to improve vascular function in overweight adults.
肥胖会促进多种主要心血管危险因素的发展。此外，过多的肥胖可能在引发动脉粥样硬化中起直接作用，因为脂肪细胞能够通过多种机制影响全身血管系统。最近的研究表明，肥胖本身可能损害血管内皮功能。这一点很重要，因为内皮功能障碍是动脉粥样硬化发病机制和引发急性缺血事件的关键因素。目前，很少有研究确定体重减轻对心血管结局和死亡率的有益影响。然而，一些实验表明，体重减轻可导致内皮功能改善，内皮功能是心血管风险的一个经过验证的替代指标。体重减轻恢复血管健康的机制可能是多因素的。然而，脂肪减少与规定的特定饮食方案相比的相对重要性、同时进行运动的作用以及药物的直接作用仍不清楚。其他几个未解决的问题，如改善的持续时间、所需的体重减轻量以及内皮功能的改善是否真的能转化为心血管事件的减少，也有待确定。尽管如此，导致体重减轻的生活方式改变能够改善超重成年人的血管功能。
