Division of Cardiology, Albany Medical Center, Albany, NY 12204, USA.
Cardiol Rev. 2011 Jan-Feb;19(1):1-4. doi: 10.1097/CRD.0b013e3181f877d2.
Obesity is reaching epidemic proportions in the United States. Obesity adversely affects the circulatory system with resultant endothelial dysfunction, which promotes systemic hypertension, coronary artery disease, and vascular calcification. It is believed that the release of adipokines is responsible for this effect. In addition, obesity causes intrinsic changes in the heart including an increase in left ventricular (LV) mass, LV hypertrophy, LV dilatation, left atrial dilatation, and diastolic, as well as systolic dysfunction in some cases. The combination of increased adipose cells and an increase lean muscle mass in obese patients results in high cardiac output and an accompanying increased circulating volume leading to these adaptive changes. Weight loss by means of caloric restriction or surgery results in favorable hemodynamic changes referred to as "reverse remodeling." Regression of LV mass and chamber size has been shown universally. However, some studies have failed to reveal improvement in diastolic function possibly because of confounders such as nutritional deficiency that may occur after weight loss surgery. Some evidence seems to suggest that the greatest regression of LV mass and LV hypertrophy may occur when weight loss is combined with beta-adrenergic blocker therapy (in those who have an indication for the drug) when compared with other antihypertensive drugs versus weight loss alone.
肥胖在美国已达到流行的程度。肥胖对循环系统造成不利影响，导致内皮功能障碍，从而促进全身性高血压、冠状动脉疾病和血管钙化。据认为，脂肪因子的释放是造成这种影响的原因。此外，肥胖导致心脏的内在变化，包括左心室（LV）质量增加、LV 肥大、LV 扩张、左心房扩张以及在某些情况下舒张和收缩功能障碍。肥胖患者脂肪细胞增加和瘦肌肉质量增加导致心输出量增加和伴随的循环血量增加，从而导致这些适应性变化。通过热量限制或手术减肥会导致有利的血流动力学变化，称为“逆向重构”。已经普遍显示 LV 质量和腔室大小的回归。然而，一些研究未能揭示舒张功能的改善，可能是由于手术后体重减轻可能发生的营养缺乏等混杂因素所致。一些证据似乎表明，与单独使用其他降压药物相比，当减肥与β肾上腺素能阻滞剂治疗（对于有适应证的患者）联合使用时，LV 质量和 LV 肥大的最大回归可能发生。
