Arkin Joshua M, Alsdorf Rachel, Bigornia Sherman, Palmisano Joseph, Beal Ryan, Istfan Nawfal, Hess Donald, Apovian Caroline M, Gokce Noyan
Evans Department of Medicine and Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, Massachusetts, USA.
Am J Cardiol. 2008 Jan 1;101(1):98-101. doi: 10.1016/j.amjcard.2007.07.055.
Although excess fat mass is linked to increased cardiovascular risk, the relation between vascular phenotype and degree of obesity in high weight categories is unknown. We examined brachial artery vasomotor responses using ultrasound in 203 consecutive patients with severe obesity (mean age 44 +/- 11 years; body mass index [BMI] 46 +/- 9 kg/m(2), range 30 to 72; and body weight 128 +/- 29 kg, range 69 to 207). We studied a unique population in which 71% of subjects were characterized as morbidly obese (BMI > or =40 kg/m(2)), which included a 31% group of super-obese subjects (BMI > or =50 kg/m(2)). Brachial artery flow-mediated dilation (FMD) and nitroglycerin-mediated dilation were examined as measures of endothelium-dependent and -independent dilation, respectively, in relation to clinical, hemodynamic, and metabolic variables. Endothelial function was significantly impaired in the highest compared with the lowest tertile of body weight (FMD 6.5 +/- 4.6% vs 9.8 +/- 4.8%, p <0.001), whereas nitroglycerin-mediated dilation was similar in all groups. Univariate correlates of FMD were gender, weight, waist circumference, BMI, diastolic blood pressure, and creatinine. In multivariate analysis, weight was a strong independent significant predictor of FMD (beta = -0.23, p = 0.005) in addition to gender. Within an overweight population, cumulative weight burden remains strongly linked to progressive arterial dysfunction. In conclusion, these results suggest that cardiovascular risks intensify with higher degrees of obesity and underscore the importance of therapeutic weight loss interventions.
尽管脂肪量过多与心血管风险增加有关，但在高体重人群中，血管表型与肥胖程度之间的关系尚不清楚。我们对203例连续的重度肥胖患者（平均年龄44±11岁；体重指数[BMI]为46±9kg/m²，范围30至72；体重128±29kg，范围69至207）进行了超声检查肱动脉血管舒缩反应。我们研究了一个独特的人群，其中71%的受试者被归类为病态肥胖（BMI≥40kg/m²），其中包括31%的超级肥胖受试者（BMI≥50kg/m²）。分别检测肱动脉血流介导的舒张功能（FMD）和硝酸甘油介导的舒张功能，作为内皮依赖性和非内皮依赖性舒张功能的指标，并与临床、血流动力学和代谢变量进行相关性分析。与体重最低三分位数相比，体重最高三分位数的患者内皮功能明显受损（FMD分别为6.5±4.6%和9.8±4.8%，p<0.001），而硝酸甘油介导的舒张功能在所有组中相似。FMD的单变量相关因素包括性别、体重、腰围、BMI、舒张压和肌酐。在多变量分析中，除性别外，体重是FMD的一个强有力的独立显著预测因素（β=-0.23，p=0.005）。在超重人群中，累积体重负担仍然与动脉功能进行性障碍密切相关。总之，这些结果表明，心血管风险随着肥胖程度的增加而加剧，并强调了治疗性减重干预的重要性。
