Andreotti Felicita, Rio Teresa, Lavorgna Alberto, Coluzzi Giulio, Santucci Eleonora, Cecchetti Silvia, Pennestrì Faustino, Crea Filippo
Istituto di Cardiologia, Dipartimento di Medicina Cardiovascolare, Policlinico Universitario A. Gemelli, Roma.
Recenti Prog Med. 2009 Oct;100(10):447-50.
Excessive body mass among healthy subjects carries an increased risk of subsequent cardiovascular events. Excess weight implies the presence of white, viscero-abdominal fat, that promotes insulin-resistance, is infiltrated by macrophages, and is less differentiated compared to subcutaneous or brown fat. Conversely, among patients with cardiovascular disease, slim patients have a greater risk of recurrent atherothrombotic events than fatter patients ("obesity paradox"). Lean patients with cardiovascular disease, on average, have more comorbidities and haemorrhagic complications than their heavier counteparts, and probably they conceal predisposing factors that are still unknown and therefore difficult to treat.
健康人群中体重超标会增加后续发生心血管事件的风险。超重意味着存在白色内脏脂肪，这种脂肪会促进胰岛素抵抗，有巨噬细胞浸润，且与皮下脂肪或棕色脂肪相比分化程度较低。相反，在心血管疾病患者中，体型消瘦的患者比肥胖患者发生复发性动脉粥样血栓形成事件的风险更高（“肥胖悖论”）。患有心血管疾病的瘦患者平均比体重较重的患者有更多的合并症和出血并发症，而且他们可能隐藏着仍不为人知因而难以治疗的易感因素。
