Eroğlu Serpil, Sade Leyla Elif, Bozbaş Hüseyin, Müderrisoğlu Haldun
Department of Cardiology, Medicine Faculty of Başkent University, Ankara, Turkey.
Turk Kardiyol Dern Ars. 2009 Sep;37(6):391-6.
Obesity is associated with an increased rate of cardiovascular disease and risk factors. It is a common problem in apparently healthy women. We aimed to investigate the association between obesity and coronary flow reserve (CFR) in obese women.
The study included 80 consecutive women (mean age 55.6+/-10.2 years) without diabetes mellitus and clinical coronary artery disease. Body mass index (BMI) was calculated and obesity was defined as BMI = or >30 kg/m(2). Based on BMI, the patients were grouped as normal weight (n=13; 18.5-24.9 kg/m(2)), overweight (n=32; 25-29.9 kg/m(2)), obese (n=32; = or >30-39.9 kg/m(2)), and morbid obese (n=3; = or > 40 kg/m(2)). Peak diastolic coronary flow velocities were measured in the distal left anterior descending artery by transthoracic pulsed wave Doppler echocardiography at baseline and after dipyridamole infusion and CFR was calculated as the ratio of hyperemic to baseline peak diastolic velocities.
There were 35 obese women (43.8%). Coronary flow reserve was significantly lower in obese women than in nonobese subjects (2.2+/-0.5 vs. 2.5+/-0.4; p=0.022). The lowest CFR was seen in patients with a BMI of = or > 40 kg/m(2); overweight women did not differ significantly from women of normal weight. Coronary flow reserve was correlated with BMI (r=-0.314, p=0.005), waist circumference (r=-0.316, p=0.005), C-reactive protein (CRP) (r=-0.342, p=0.011), and adiponectin level (r=0.410, p=0.011). In regression analysis, BMI (p=0.017), waist circumference (p=0.048), systolic blood pressure (p=0.025), fasting glucose (p=0.035), and adiponectin level (p=0.037) were found to be independent predictors for impaired CFR. In ROC analysis, the cut-off value for BMI to predict impaired CFR was = or > 30 kg/m(2), with 76% sensitivity and 72% specificity (ROC area 0.805, p<0.001, 95% CI 0.669-0.96).
Impaired CFR in obese women suggests the presence of microvascular dysfunction. Treatment of obesity is important for the prevention of atherosclerosis.
肥胖与心血管疾病发病率及危险因素增加相关。这在看似健康的女性中是个常见问题。我们旨在研究肥胖女性中肥胖与冠状动脉血流储备（CFR）之间的关联。
该研究纳入了80名连续的无糖尿病及临床冠状动脉疾病的女性（平均年龄55.6±10.2岁）。计算体重指数（BMI），肥胖定义为BMI = 或>30 kg/m²。根据BMI，将患者分为正常体重组（n = 13；18.5 - 24.9 kg/m²）、超重组（n = 32；25 - 29.9 kg/m²）、肥胖组（n = 32；= 或>30 - 39.9 kg/m²）和病态肥胖组（n = 3；= 或>40 kg/m²）。在基线及双嘧达莫输注后，通过经胸脉冲波多普勒超声心动图测量左前降支远端的舒张期峰值冠状动脉血流速度，并将CFR计算为充血期与基线舒张期峰值速度之比。
有35名肥胖女性（43.8%）。肥胖女性的冠状动脉血流储备显著低于非肥胖受试者（2.2±0.5 vs. 2.5±0.4；p = 0.022）。BMI = 或>40 kg/m²的患者CFR最低；超重女性与正常体重女性无显著差异。冠状动脉血流储备与BMI（r = -0.314，p = 0.005）、腰围（r = -0.316，p = 0.005）、C反应蛋白（CRP）（r = -0.342，p = 0.011）和脂联素水平（r = 0.410，p = 0.011）相关。在回归分析中，发现BMI（p = 0.017）、腰围（p = 0.048）、收缩压（p = 0.025）、空腹血糖（p = 0.035）和脂联素水平（p = 0.037）是CFR受损的独立预测因素。在ROC分析中，预测CFR受损的BMI临界值为= 或>30 kg/m²，敏感性为76%，特异性为72%（ROC曲线下面积0.805，p<0.001，95%CI 0.669 - 0.96）。
肥胖女性的CFR受损提示存在微血管功能障碍。肥胖的治疗对预防动脉粥样硬化很重要。
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