Artham Surya M, Lavie Carl J, Milani Richard V, Ventura Hector O
Ochsner Clinic Foundation, New Orleans, LA.
Ochsner J. 2009 Fall;9(3):124-32.
Obesity prevalence has reached epidemic proportions and is independently associated with numerous cardiovascular disease (CVD) risk factors, including diabetes mellitus, hypertension, dyslipidemia, cancers, sleep apnea, and other major CVDs. Obesity has significant negative impact on CVD, including hypertension, coronary heart disease, heart failure, and arrhythmias via its maladaptive effects on individual CVD risk factors and cardiac structure and function. Despite this negative association between obesity and the incidence and prevalence of CVD, many studies have demonstrated that obese patients with established CVD might have better short- and long-term prognosis, suggesting an "obesity paradox." This intriguing phenomenon has been well documented in populations with heart failure, coronary heart disease, and hypertension. This review summarizes the adverse effects of obesity on individual CVD risk factors; its role in the genesis of CVDs, including heart failure, coronary heart disease, and hypertension; and the obesity paradox observed in these populations and the potential underlying mechanisms behind this puzzling phenomenon and concludes with a discussion on the potential benefits of weight reduction.
肥胖患病率已达到流行程度，并与众多心血管疾病（CVD）风险因素独立相关，包括糖尿病、高血压、血脂异常、癌症、睡眠呼吸暂停及其他主要心血管疾病。肥胖通过对个体心血管疾病风险因素以及心脏结构和功能产生适应不良影响，对心血管疾病有显著负面影响，包括高血压、冠心病、心力衰竭和心律失常。尽管肥胖与心血管疾病的发病率和患病率之间存在这种负相关关系，但许多研究表明，患有已确诊心血管疾病的肥胖患者可能有较好的短期和长期预后，这表明存在“肥胖悖论”。这种有趣的现象在心力衰竭、冠心病和高血压人群中已有充分记录。本综述总结了肥胖对个体心血管疾病风险因素的不良影响；其在心血管疾病发生中的作用，包括心力衰竭、冠心病和高血压；以及在这些人群中观察到的肥胖悖论及其背后潜在的机制，并最后讨论了体重减轻的潜在益处。
